Cataracts Research: 2002-2006
     
Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003169.
Multifocal versus monofocal intraocular lenses after cataract extraction.
Leyland M, Pringle E.
Frimley Park NHS Trust, Department of Ophthalmology, Portsmouth Road, Frimley, Surrey, UK.

BACKGROUND: Good unaided distance visual acuity is now a realistic expectation following cataract surgery and intraocular lens (IOL) implantation. Near vision however still requires additional refractive power usually in the form of reading glasses. Multiple optic (multifocal) IOLs are available which claim to allow good vision at a range of distances. It is unclear whether this benefit outweighs the optical compromises inherent in multifocal IOLs. OBJECTIVES: The objective of this review was to assess the effects of multifocal IOLs, including effects on visual acuity, subjective visual satisfaction, spectacle dependence, glare and contrast sensitivity, compared to standard monofocal lenses. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which includes the Eyes and Vision Group Trials Register) on The Cochrane Library (2006, Issue 3), MEDLINE (1966 to July 2006), EMBASE (1980 to July 2006), NRR (2006, Issue 3) and PUBMED searched on 25 July 2006, limit: 90 days (entry date). We searched the reference lists of relevant articles and contacted investigators of included studies and manufacturers of multifocal intraocular lenses for information about additional published and unpublished studies. SELECTION CRITERIA: All randomised controlled trials comparing a multifocal IOL of any type with a monofocal IOL as control were included. Both unilateral and bilateral implantation trials were included. DATA COLLECTION AND ANALYSIS: Data were collected and trial quality was assessed. Where possible, statistical summary measures were calculated otherwise data were tabulated. MAIN RESULTS: Ten trials were identified, and a further three are pending review. There was significant variability between the trials in which outcomes were reported. Unaided distance acuity was similar in multifocal and monofocal IOLs (standardised mean difference (SMD) 0.03, 95% Confidence Interval (CI) -0.13 to 0.19). There was no statistical difference between multifocal IOLs and monofocals with respect to the proportion of participants achieving 6/6 best corrected visual acuity (Peto odds ratio (OR) 1.05, 95% CI 0.67 to 1.63). Unaided near vision was improved with the multifocal IOLs. Total freedom from use of glasses was achieved more frequently with multifocal than monofocal IOLs (OR for spectacle dependence 0.17, 95% CI 0.12 to 0.24). Adverse effects included reduced contrast sensitivity and the subjective experience of haloes around lights. AUTHORS' CONCLUSIONS: Multifocal IOLs are effective at improving near vision relative to monofocal IOLs. Whether that improvement outweighs the adverse effects of multifocal IOLs will vary between patients. Motivation to achieve spectacle independence is likely to be the deciding factor.

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Cochrane Database Syst Rev. 2006 Oct 18;(4):CD001323.
Surgical interventions for age-related cataract.
Riaz Y, Mehta JS, Wormald R, Evans JR, Foster A, Ravilla T, Snellingen T.
Moorfields Eye Hospital, City Road, London, UK. yasmin.riaz@gmail.com

BACKGROUND: Cataract accounts for 50% of blindness globally and remains the leading cause of visual impairment in all regions of the world, despite improvements in surgical outcomes (WHO 2005). This number is expected to rise due to an aging population and increase in life expectancy. Although cataracts are not preventable, their surgical treatment is one of the most cost-effective interventions in healthcare. OBJECTIVES: To compare the effects of different surgical interventions for age-related cataract. SEARCH STRATEGY: We searched CENTRAL, MEDLINE, EMBASE up to July 2006, NRR Issue 3 2005, the reference lists of identified trials and we contacted investigators and experts in the field for details of published and unpublished trials. SELECTION CRITERIA: We included randomised controlled trials (RCTS). DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and discrepancies were resolved by discussion. Where appropriate, risk ratios, odds ratios and weighted mean differences were summarised after assessing heterogeneity between the studies. MAIN RESULTS: We identified 17 trials that randomised a total of 9627 people. Phacoemulsification gave a better visual outcome than extracapsular surgery but similar average cost per procedure in Europe but not in poorer countries. Extracapsular surgery with posterior chamber lens implant and ICCE with or without an anterior chamber intraocular lens (IOL) implant gave acceptable visual outcomes but extracapsular surgery had less complications. Manual small incision surgery provides better visual outcome than ECCE but slightly inferior unaided visual acuity compared to phacoemulsification. AUTHORS' CONCLUSIONS: This review provides evidence from seven RCTs that phacoemulsification gives a better outcome than ECCE with sutures. We also found evidence that ECCE with a posterior chamber lens implant provides better visual outcome than ICCE with aphakic glasses. The long term effect of posterior capsular opacification (PCO) needs to be assessed in larger populations. The data also suggests that ICCE with an anterior chamber lens implant is an effective alternative to ICCE with aphakic glasses, with similar safety. Phacoemulsification provides the best visual outcomes but will only be accessible to the poorer countries if the cost of phacoemulsification and foldable IOLs decrease. Manual small incision cataract surgery provides early visual rehabilitation and comparable visual outcome to PHACO. It has better visual outcomes than ECCE and can be used in any clinic that is currently carrying out ECCE with IOL. Further research from developing regions are needed to compare the cost and longer term outcomes of these procedures e.g. PCO and corneal endothelial cell damage.

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J Cataract Refract Surg. 2006 Oct;32(10):1672-7.
Primary intraocular lens implantation in infants: complications and visual results.
Lundvall A, Zetterstrom C.
St Erik's Eye Hospital, Karolinska Institute, Stockholm, Sweden. anna.lundvall@sankterik.se

PURPOSE: To evaluate the complications and visual results in a consecutive series of patients having cataract extraction with intraocular lens (IOL) implantation in the first year of life. SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: This retrospective study comprised 28 children (31 eyes) who had cataract surgery with primary IOL implantation. RESULTS: The median age at surgery was 2.5 months (range 8 days to 10 months). The median follow-up was 36 months. Two newborns with persistent fetal vasculature (PFV) who had surgery at 8 days and 17 days, respectively, developed intraoperative vitreous hemorrhage; a retinal detachment developed in 1 of the eyes. Intraocular lens luxation occurred in 2 infants with PFV. Seventy percent of eyes developed opacification of the visual axis that required additional surgery. Chronic glaucoma developed in 2 eyes and transitory glaucoma in 1 eye. Two of the glaucoma cases occurred in eyes with PFV. In 7 eyes of 4 infants with bilateral cataract, the median visual acuity was 20/63 (range 20/25 to 20/100). In 12 infants with unilateral cataract without PFV, 7 achieved a visual acuity between 20/32 and 20/200 (median 20/63), 4 achieved counting fingers (CF), and 1 achieved light perception. In 12 eyes with PFV, 2 achieved a visual acuity of 20/200 and the rest achieved CF or worse. CONCLUSIONS: After-cataract with membrane formation was the main complication in infants with primary IOL implantation. The glaucoma incidence was low at the last follow-up.

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J Cataract Refract Surg. 2006 Oct;32(10):1632-7.
One-year follow-up of bag-in-the-lens intraocular lens implantation in 60 eyes.
De Groot V, Leysen I, Neuhann T, Gobin L, Tassignon MJ.
Department of Ophthalmology, University of Antwerp, Edegem, Belgium. veva.de.groot@uza.be

PURPOSE: To report the feasibility and clinical results of implanting a bag-in-the-lens intraocular lens (IOL) designed to prevent posterior capsule opacification after cataract surgery. SETTING: Departments of Ophthalmology, University of Antwerp, Antwerp, Belgium, and University of Munich, Munich, Germany. METHODS: This prospective study comprised 63 eyes (55 patients; 7 children, 48 adults) scheduled for cataract surgery and bag-in-the-lens IOL implantation. A posterior curvilinear capsulorhexis the same size as the anterior capsulorhexis was created for IOL insertion. After surgery, lens epithelial cell (LEC) proliferation was documented every 6 months with a minimum follow-up of 12 months. RESULTS: Sixty of 63 eyes (95%) had implantation of the bag-in-the-lens IOL. Conversion to a conventional IOL was necessary in 2 cases. In 1 eye, postoperative luxation of the IOL into the vitreous occurred as a result of an oversized anterior and posterior capsulorhexis. Three eyes had early postoperative iris incarceration in the lens groove that required surgery. No LEC proliferation on the optic occurred during a mean follow-up of 22.7 months (range 12 to 64 months); LEC proliferation was confined to the peripheral capsular bag. CONCLUSION: Lens epithelial cell proliferation was mild and confined to the periphery of the capsular bag during follow-up, and the bag-in-the-lens IOL optic remained clear.

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J Cataract Refract Surg. 2006 Oct;32(10):1627-31.
Posterior capsule opacification after implantation of a hydrophilic or a hydrophobic acrylic intraocular lens: one-year follow-up.
Kugelberg M, Wejde G, Jayaram H, Zetterstrom C.
St Erik's Eye Hospital, Karolinska Institute, Stockholm, Sweden. m.kugelberg@sankterik.se

PURPOSE: To evaluate the effect of hydrophilic and hydrophobic single-piece acrylic intraocular lenses (IOLs) on posterior capsule opacification (PCO) after cataract surgery. SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: In a prospective study, 120 patients having cataract surgery were randomized to implantation of a hydrophilic acrylic IOL (BL27, Bausch & Lomb) or a hydrophobic acrylic IOL (AcrySof SA60AT, Alcon). Surgery was performed according to a standardized protocol by 1 of 3 surgeons. Best corrected visual acuity, contrast sensitivity, glare, intraocular pressure, and flare were measured 1 week, 3 months, and 1 year after surgery. Posterior capsule opacification was assessed by digital retroillumination photography and analysis using POCOman software at 1 year. The rate of neodymium:YAG (Nd:YAG) capsulotomy for each IOL was also recorded. RESULTS: At 1 year, the hydrophilic acrylic IOL group had a significantly greater percentage area and severity of PCO than the hydrophobic acrylic IOL group (P<.001). Two patients in the hydrophilic acrylic IOL group and 4 in the hydrophobic acrylic IOL group had an Nd:YAG capsulotomy within the first year (P>.05). Contrast sensitivity was significantly better in the hydrophilic acrylic group at 3 months (P<.05); however, at 12 months no difference between the IOLs was observed. There was no significant difference in the other measured parameters. CONCLUSION: Patients with the hydrophilic acrylic BL27 IOL had a significantly greater percentage area and severity of PCO than those with the hydrophobic acrylic SA60AT IOL 1 year after surgery.

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Saudi Med J. 2006 Sep;27(9):1296-301.
A Cochrane Systematic Review finds no significant difference in outcome or risk of postoperative complications between day care and in-patient cataract surgery.
Fedorowicz Z, Lawrence DJ, Gutierrez P.
UK Cochrane Centre, UK. zbysfedo@batelco.com.bh

This review was conducted to determine reliable evidence regarding the safety, feasibility, effectiveness, and cost-effectiveness of cataract extraction performed as a day care versus in-patient procedure. The search to identify randomized controlled trials comparing day care and in-patient surgery for age-related cataract included the Cochrane Eyes and Vision Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and LILACS Latin American and Caribbean Literature on Health Sciences. Assessment of methodological quality was based on criteria defined by the Cochrane Collaboration. The primary outcome was the achievement of a satisfactory visual acuity 6 weeks after operation. Two trials, involving a total of 1284 people, are included. One trial reported statistically significant differences in early postoperative complication rates in the day care group, which had no clinical relevance to visual outcomes 4 months postoperatively. Mean change in visual acuity Snellen lines of the operated eye 4 months postoperatively was 4.1 standard deviation SD 2.3 for the day care group and 4.1 SD 2.2 for the in-patient group. Costs were 20% more for the in-patient group attributable to higher costs for overnight stay.

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J Cataract Refract Surg. 2006 Sep;32(9):1513-20.
Effect of anterior capsule polishing on the posterior capsule opacification-inhibiting properties of a sharp-edged, 3-piece, silicone intraocular lens: three- and 5-year results of a randomized trial.
Bolz M, Menapace R, Findl O, Sacu S, Buehl W, Wirtitsch M, Leydolt C, Kriechbaum K.
Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.

PURPOSE: To evaluate the long-term effects of anterior capsule polishing on regeneratory posterior capsule opacification (PCO), anterior capsule opacification (ACO), and fibrotic PCO with a silicone intraocular lens (IOL) with sharp optic edges. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: This prospective bilateral randomized patient- and examiner-masked clinical trial comprised 130 eyes of 65 patients with bilateral age-related cataract. All eyes had implantation of a 3-piece silicone IOL with a truncated, sharp-edged optic (CeeOn Edge 911A, Advanced Medical Optics). In 1 eye, the anterior capsule was extensively polished using an aspiration curette after phacoemulsification and cortex aspiration. Regenerative PCO was quantified objectively, while ACO and fibrotic PCO were graded subjectively 1, 2, 3, and 5 years postoperatively. RESULTS: The mean ACO score was significantly lower in the eyes in which the anterior capsule had been polished (1 year, P<.02; 2 years, P<.03; 3 years, P<.01; 5 years, P<.01). The mean difference in regeneratory PCO and fibrotic PCO scores between the 2 groups was not statistically significant. CONCLUSIONS: Three years after cataract surgery, eyes in which the anterior capsule had been polished had significantly less ACO. However, polishing did not lower PCO intensity when a sharp-edged CeeOn 911A IOL was implanted in the bag. Although results indicate that anterior capsule polishing may enhance the development of regeneratory PCO, this trend did not reach statistical significance.

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Ophthalmology. 2006 Aug 24; [Epub ahead of print]
Cataract Surgery and the 10-Year Incidence of Age-Related Maculopathy The Blue Mountains Eye Study.
Cugati S, Mitchell P, Rochtchina E, Tan AG, Smith W, Wang JJ.
Centre for Vision Research, Department of Ophthalmology and the Westmead Millennium Institute, University of Sydney, Sydney, Australia.

PURPOSE: To assess the long-term (10-year) risk of late age-related maculopathy (ARM) in eyes that had previously undergone cataract surgery (before the baseline examination). DESIGN: Population-based cohort study. PARTICIPANTS: In the Blue Mountains Eye Study (BMES) cohort, 2335 of 3654 baseline participants >/=49 years old (75% of survivors) were reexamined after 5 years and 1952 (76% of survivors) were reexamined after 10 years. METHODS: At the baseline examination, nonphakic (aphakic or pseudophakic) eyes were identified at slit-lamp examination and confirmed at lens photographic grading. Side-by-side grading of baseline and follow-up stereoretinal photographs was performed using the Wisconsin ARM grading system. Eye-specific data were analyzed using Kaplan-Meier estimates and generalized estimating equation models, adjusting for correlation between the 2 eyes. MAIN OUTCOME MEASURES: Incident late ARM was defined if either neovascular ARM or geographic atrophy developed in eyes without either lesion at baseline. RESULTS: After excluding eyes with either late ARM lesion at baseline or that had missing photographs at either examination, 4763 eyes were considered at risk of incident late ARM, including 132 eyes that had cataract surgery before the baseline examination. Late ARM developed in 10 of 132 nonphakic eyes (7.6%) compared to 96 of 4631 phakic eyes (2.1%). After adjusting for baseline age, gender, smoking, and presence of early ARM lesions, nonphakic (cataract surgical) eyes had a 3-fold risk of developing late-stage ARM (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.1-9.9) or neovascular ARM (OR, 3.4; 95% CI, 1.1-10.9) compared to phakic eyes. CONCLUSIONS: Our findings support the hypothesis that the long-term risk of developing late ARM is higher in cataract surgical eyes, consistent with findings from the Beaver Dam Eye Study.

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Cochrane Database Syst Rev. 2006 Jul 19;3:CD003171.
Surgical interventions for bilateral congenital cataract.
Long V, Chen S, Hatt S.

BACKGROUND: Congenital cataracts are opacities of the lens in one or both eyes of children that cause a reduction in vision severe enough to require surgery. Cataract is the largest treatable cause of visual loss in childhood. Paediatric cataracts provide different challenges to those in adults. Intense inflammation, amblyopia and posterior capsule opacification can affect results of treatment. Two treatments commonly considered for congenital cataract are lensectomy and lens aspiration. OBJECTIVES: The objective of this review was to assess the effects of surgical treatments for bilateral symmetrical congenital cataracts. Success was measured according to the vision attained and occurrence of adverse events. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochane Library, which contains the Cochrane Eyes and Vision Group Trials Register (2005, Issue 2), MEDLINE (1966 to June 2005), EMBASE (1980 to June 2005, week 27), LILACS (6 July 2005), the Science Citation Index and the reference list of the included studies. We also contacted trial investigators and experts in the field for details of further studies. SELECTION CRITERIA: We included all prospective, randomised controlled trials that compared one type of cataract surgery to another, or to no surgery, in children with bilateral congenital cataracts aged 15 years or younger. DATA COLLECTION AND ANALYSIS: Two authors extracted data. No meta-analysis was performed. MAIN RESULTS: Four trials met the inclusion criteria. All trials were concerned with reducing the development of visual axis opacification (VAO). This was achieved with techniques that included an anterior vitrectomy or optic capture. Posterior capsulotomy alone was inadequate except in older children. AUTHORS' CONCLUSIONS: Evidence exists for the care of children with congenital or developmental bilateral cataracts to reduce the occurrence of visual axis opacification. Further randomised trials are required to inform modern practice about other concerns including the timing of surgery, age for implantation of an intraocular lens and development of long-term complications such as glaucoma and retinal detachment.

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Klin Monatsbl Augenheilkd. 2006 Jul;223(7):559-67.
[Pharmacological means to prevent secondary cataract.]
[Article in German]
Rabsilber TM, Auffarth GU.
Univ.-Augenklinik, Ruprecht-Karls-Universitat Heidelberg.

Secondary cataract or posterior capsule opacification (PCO) is still the most frequent long-term complication of cataract surgery. Tremendous advances have been made, especially during the last 10 to 15 years, in terms of surgical techniques and improvement of implant technology. However, the problem of proliferation and migration of lens epithelial cells (LECs) postoperatively has not yet been solved completely although we know that a sharp optic edge of intraocular lenses (IOL) combined with hydrodissection, complete overlapping of capsulorhexis and IOL-optic as well as capsular bending reduce PCO formation significantly. In the 1980 s, investigators like Hartmann et al. began with the application of pharmacological substances in-vitro in order to successfully prevent LECs from proliferating and migrating. Cytostatic drugs, steroids, non-steroidal antiphlogistics, adhesion inhibitors, heparin, lidocaine, suramin, immunotoxins, photodynamic therapy and osmotic effective solutions were tested. In several studies different drug delivery systems were investigated in order to provide a longer and more effective impact on LECs. However, the in-vivo use has been viewed critically since the selective targeting of LECs was not possible and serious damage to the surrounding tissue had to be considered. Recently, the development of the PerfectCapsule System for vacuum-sealed capsule irrigation allows the selective targeting of LECs inside the capsular bag. This survey gives an update on past, current and future means and trends to reduce or prevent PCO formation pharmacologically.

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Br J Ophthalmol. 2006 Jul 19; [Epub ahead of print]
The international intravitreal bevacizumab safety survey: Using the internet to assess drug safety worldwide.
Fung AE, Rosenfeld PJ, Reichel E.
Pacific Eye Associates, United States.

PURPOSE: Off-label intravitreal injections of bevacizumab (Avastin) have been performed for the treatment of neovascular and exudative ocular diseases since May 2005. Since then, the use of intravitreal bevacizumab has spread worldwide, but the drug-related adverse events (AEs) associated with its use have only been reported in a few retrospective reviews. The International Intravitreal Bevacizumab Survey was initiated to gather timely information regarding adverse events from physicians around the world via the internet. METHODS: An internet based survey was designed to identify adverse events (AEs) associated with intravitreal bevacizumab therapy. The survey web address was disseminated to the international vitreoretinal community via email. Rates of AEs were calculated from participant responses. RESULTS: Seventy centers from 12 countries reported on 7,113 injections performed on 5,228 patients. Physician-reported AEs included corneal abrasion, lens Injury, endophthalmitis, retinal detachment, inflammation / uveitis, cataract progression, acute vision loss, central retinal artery occlusion, subretinal haemorrhage, retinal pigment epithelium tears, blood pressure elevation, transient ischemic attack, cerebrovascular accident and death. None of the AE rates exceeded 0.21%. CONCLUSION: Intravitreal bevacizumab is being used globally for ocular diseases. Self-reporting of adverse events following intravitreal bevacizumab injections did not reveal an increased rate of potential drug-related ocular or systemic events. These short-term results suggest that intravitreal bevacizumab appears safe.

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Br J Ophthalmol. 2006 Jul 6; [Epub ahead of print]
Bilateral cataract surgery and driving performance.
Wood JM, Carberry TP.
Queensland University of Technology, Australia.

BACKGROUND/AIMS: Cataract surgery is one of the most common medical procedures undertaken world-wide. This study aimed to investigate whether cataract surgery can improve driving performance and whether this can be predicted by changes in visual function. METHODS: Twenty nine older participants with bilateral cataracts and eighteen control participants with normal vision were tested. All were licensed drivers. Driving and vision performance were measured prior to cataract surgery and after second eye surgery for the cataract participants and on two separate occasions for the controls. Driving performance was assessed on a closed-road circuit. visual acuity, contrast sensitivity, glare sensitivity and kinetic visual fields were measured at each test session. RESULTS: The cataract participants had significantly poorer driving performance at the first visit compared to the control participants for a range of measures of driving performance, which significantly improved to the level of the control participants following extraction of both cataracts. The change in contrast sensitivity following surgery was the best predictor of the improvements in driving performance in the cataract participants. CONCLUSIONS: Cataract surgery results in significant improvements in driving performance and these improvements are related to concurrent improvements in contrast sensitivity.

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Eye. 2006 Jun 9; [Epub ahead of print]
Comparison of epilenticular IOL implantation vs technique of anterior and primary posterior capsulorhexis with anterior vitrectomy in paediatric cataract surgery.
Rastogi A, Monga S, Khurana C, Anand K.
Pediatric Ophthalmology Service, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India.

PurposeTo compare the functional outcome of epilenticular intraocular lens (IOL) implantation vsthe technique of anterior continuous curvilinear capsulorhexis (ACCC), posterior continuous curvilinear capsulorhexis (PCCC) with vitrectomy and in-the-bag IOL implantation in paediatric cataract surgery.MethodsForty eyes of 33 children with developmental or traumatic cataract, whose mean age was 2-12 years, were randomly divided into two groups A and B. Group A patients underwent epilenticular IOL implantation while in group B patients, ACCC, PCCC with anterior vitrectomy with in-the-bag IOL implantation was performed. Equal number of eyes (10 each) with developmental cataracts (subgroups A1 and B1) and traumatic cataracts (subgroups A2 and B2) were allotted to both the groups. Postoperative visual acuity, opacification of the visual axis, and possible complications were observed and analysed.ResultsFour eyes in subgroup B2 had fibrous or ruptured capsules, and were managed by epilenticular IOL implantation technique. One eye in subgroup B2 developed central posterior capsular opacification and hence required a secondary capsulotomy. All cases in group A maintained a clear visual axis at the last follow-up. Minimal postoperative inflammation was noticed in all groups, which subsided with anti-inflammatory medication. At the last follow-up, all eyes in group A gained visual acuity >/=6/18. Whereas in group B, visual acuity >/=6/18 was obtained in 85.7% cases with the epilenticular IOL implantation technique and in 83.3% cases with ACCC and PCCC with anterior vitrectomy technique.ConclusionEpilenticular IOL implantation offers a safe and effective alternative for management of paediatric cataract. In selected cases of traumatic cataract, it is the preferred treatment modality.Eye advance online publication, 9 June 2006; doi:10.1038/sj.eye.6702451.

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Ophthalmic Res. 2006 Jun 6;38(4):218-245 [Epub ahead of print]
Intravitreal Triamcinolone Acetonide: A Change in a Paradigm.
Jonas JB.
Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, Ruprecht Karls University of Heidelberg, Heidelberg, Germany.

Background: Based on experimental studies and clinical observations by Robert Machemer, Gholam Peyman and others, the vitreous cavity has increasingly been used as a reservoir of drugs for the direct treatment of intraocular diseases. Methods and Results: The most widely injected drug so far has been triamcinolone acetonide for various intraocular neovascular and edematous diseases. Comparing the various diseases with respect to effect and side effects of the treatment, the best response in terms of gain in visual acuity has been achieved for intraretinal edematous diseases such as diffuse diabetic macular edema, branch retinal vein occlusion, central retinal vein occlusion, and pseudophakic cystoid macular edema. In eyes with various types of noninfectious uveitis including acute or chronic sympathetic ophthalmia and Adamantiadis-Behcet's disease, visual acuity increased and the degree of intraocular inflammation decreased. Some studies have suggested that intra- vitreal triamcinolone may be useful as an angiostatic agent in eyes with iris neovascularization and proliferative ischemic retinopathies. Intravitreal triamcinolone may possibly be helpful as adjunct therapy for exudative age-related macular degeneration, particularly in combination with photodynamic therapy. In eyes with chronic, therapy-resistant ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure and may stabilize the eye. The complications of intravitreal triamcinolone therapy include secondary ocular hypertension in about 40% of the eyes injected; medically uncontrollable high intraocular pressure leading to antiglaucomatous surgery in about 1-2% of the eyes; posterior subcapsular cataract and nuclear cataract leading to cataract surgery in about 15-20% in elderly patients within 1 year after injection; postoperative infectious endophthalmitis with a rate of about 1:1,000; noninfectious endophthalmitis, perhaps due to a reaction to the solvent agent, and pseudoendophthalmitis with triamcinolone acetonide crystals appearing in the anterior chamber. Intravitreal triamcinolone injection can be combined with other types of intraocular surgery including cataract surgery, particularly in eyes with iris neovascularization. Cataract surgery performed some months after the injection does not show a markedly elevated complication rate. The injection may be repeated, if vision redecreases. In nonvitrectomized eyes, the duration of the effect and side effects of a single intravitreal injection of triamcinolone is about 6-9 months for a dosage of about 20 mg, and about 2-4 months for a dosage of 4 mg. It has remained unclear so far, whether and how to remove the solvent agent. In the future, intravitreal triamcinolone may be combined with other antiangiogenic drugs for the treatment of exudative age-related macular degeneration or with neuroprotective drugs for treatment of diabetic retinopathy. Conclusions: Despite an exponentially increasing number of mostly case-series studies, the intravitreal injection of triamcinolone may still be considered an experimental procedure until randomized studies have been presented. Copyright (c) 2006 S. Karger AG, Basel.

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J Cataract Refract Surg. 2006 May;32(5):826-30.
Benefit to patients of bilateral same-day cataract extraction: Randomized clinical study.
Lundstrom M, Albrecht S, Nilsson M, Astrom B.
Department of Ophthalmology, Blekinge Hospital, Karlskrona, Sweden. mats.lundstrom@ltbleking.se

PURPOSE: To compare patients' self-assessed visual function after bilateral surgery performed on the same day with visual function after surgery in 1 eye at a time. SETTING: Department of Ophthalmology, Blekinge Hospital, Karlskrona, Sweden. METHODS: Patients with bilateral cataract were assigned randomly to 2 groups, patients having bilateral surgery on the same day and patients with 2 surgeries done 2 months apart. Both groups were examined before and 2 months and 4 months after surgery. All patients completed the Catquest questionnaire at each ophthalmic examination. RESULTS: Until both eyes were operated on, patients having surgery in 1 eye had significantly more difficulties performing daily life activities (P<.001) and a worse binocular contrast sensitivity (P<.01) than patients who had bilateral surgery on the same day. Four months after surgery of both eyes in both groups, there was no difference in visual function. CONCLUSIONS: Bilateral cataract surgery on the same day allowed rapid rehabilitation of the patient and helped avoid suboptimal visual function in daily life while waiting for second-eye surgery. However, there was no extra long-term benefit of self-assessed visual function compared with cataract surgery in 1 eye at a time.

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J Cataract Refract Surg. 2006 May;32(5):789-94.
Prospective randomized controlled trial of the effect of intracameral vancomycin and gentamicin on macular retinal thickness and visual function following cataract surgery.
Ball JL, Barrett GD.
Sir Charles Gairdner Hospital, Perth, Western Australia. jamesball@doctors.org.uk

PURPOSE: To investigate whether the use of vancomycin (20 microg/mL) and gentamicin (8 microg/mL) in the infusion fluid at the time of cataract surgery increases the incidence of macular thickening as measured with optical coherence tomography (OCT) following phacoemulsification. SETTING: A public teaching hospital in Western Australia. METHODS: Fourty-one patients (50 eyes) with cataracts between 50 and 85 years of age were randomized to receive no antibiotics in the infusion fluid at the time of cataract surgery (control group) or vancomycin (20 microg/mL) and gentamicin (8 microg/mL) in the infusion fluid (antibiotic group). Optical coherence tomography measurements were performed preoperatively and 1 day and 1 and 5 weeks postoperatively. A significant increase in macular thickness (mean of the central 1.0 mm diameter) on OCT was defined as 15 microm or greater. Five weeks postoperatively, the best corrected Snellen acuity and Pelli-Robson contrast sensitivity were measured. RESULTS: Twenty-five percent in the control group and 38% in the antibiotic group had a significant increase in macular thickness measured on OCT 5 weeks postoperatively (P = .34). The mean contrast sensitivity of patients with increased macular thickness on OCT was 1.26, and in those with no change it was 1.43 (P = .001). CONCLUSIONS: The use of intracameral vancomycin (20 microg/mL) and gentamicin (8 microg/mL) at the time of cataract surgery had no significant effect on macular thickness or visual function postoperatively. Overall, 31% of eyes showed an increase of 15 microm or greater in central retinal thickness. These patients had significantly reduced contrast sensitivity.

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J AAPOS. 2006 Feb;10(1):30-6.
Is there a latent period for the surgical treatment of children with dense bilateral congenital cataracts?
Lambert SR, Lynn MJ, Reeves R, Plager DA, Buckley EG, Wilson ME.
Emory Eye Center, Atlanta, Georgia.

Background: It generally is accepted that cataract surgery during the first 6 weeks of life is associated with the best visual outcomes for children with dense unilateral congenital cataracts. The latent period for children with dense bilateral congenital cataracts has not been clearly defined. Methods: The best-corrected visual acuity (BCVA) at 4 to 6 years of age was collected retrospectively on a series of 43 children with dense bilateral congenital cataracts from 4 institutions. All of the children underwent a lensectomy, posterior capsulotomy, and anterior vitrectomy at 36 weeks of age or younger. Results: Cataract surgery was performed at a mean age of 11.5 weeks for the better-seeing eye. BCVA was assessed when the children were a mean of 5.3 years of age. The visual acuities of 26 (60%) were 20/40 or better, 12 (28%) were 20/50 to 20/80, and 5 (12%) were 20/100 or worse. There was a trend for worse BCVA with increasing age at the time of surgery (r = 0.28, P = 0.07). We noted that a BCVA of 20/100 or worse occurred only among eyes undergoing surgery when infants were older than 10 weeks (</=10 weeks: 0/21 = 0% vs. >10 weeks: 5/22 = 23%, P = 0.049). Children with preoperative nystagmus had worse visual outcomes; only 38% of children with preoperative nystagmus achieved a BCVA of 20/40 or better compared with 74% of children without preoperative nystagmus (P = 0.03). Conclusion: Previous reports have proposed that cataract surgery during the first 5 to 8 weeks of life is associated with better visual outcomes in children with dense bilateral congenital cataracts. Our results would suggest that good visual outcomes can be achieved beyond this age, but the incidence of poor visual outcomes increases if cataract surgery is delayed beyond 10 weeks of age. The absence of preoperative nystagmus is a better predictor of a good visual outcome than the age at surgery.

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Klin Monatsbl Augenheilkd. 2006 Feb;223(2):142-146.
[Functional Results after Intraocular Lens Implantation with or without Blue Light Filter: An Intraindividual Comparison.]
[Article in German]
Mayer S, Wirbelauer C, Pham DT.
Klinik fur Augenheilkunde, Vivantes Klinikum Neukolln (Dir.: Prof. D. T. Pham), Berlin.

BACKGROUND: The new generation of intraocular lenses (IOL) with an additional blue light filter has a slight yellowish colour (compared to the IOLs with only a UV filter) due to its different light transmitting properties. This could have an effect on contrast sensitivity and subjective visual perception. PATIENTS AND METHODS: In this intraindividual prospective comparative study including 14 cataract patients without further ocular pathology, a blue light filtering IOL (SN60AT, Alcon) was implanted in one eye and 1 month later a conventional single-piece IOL (SA60AT, Alcon) was fitted into the fellow eye. The visual acuity and the clinical findings were assessed at one day and four weeks post-operatively. Contrast sensitivity was tested under defined mesopic (6 cd/m(2)) and high mesopic (18,8 cd/m(2)) light conditions in the Ginsburg Box using the Functional Acuity Contrast Test (F.A.C.T.). Furthermore, subjective differences in the visual perception of both eyes were noted. RESULTS: The contrast sensitivity testing 1 day and 1 month postoperatively, revealed no statistically significant differences (P > 0,008) between both IOL types for all spatial frequencies (1,5/3/6/12/18 cpd) and light levels. 13 patients (85 %) reported no differences in the colour perception of both eyes, and none had visual disturbances. CONCLUSION: This intraindividual comparison revealed no relevant differences concerning mesopic contrast sensitivity and the subjective visual perception after implantation of one IOL with or without a blue light filter.

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J Fr Ophtalmol. 2006 Feb;29(2):157-63.
[Quality of vision after cataract surgery in patients with prolate aspherical lens.]
[Article in French]
Denoyer A, Roger F, Majzoub S, Pisella PJ.
Service d'Ophtalmologie, Centre Hospitalo-Universitaire Bretonneau, Tours.

PURPOSE: To assess the quality of vision in pseudophakic patients with a prolate aspherical intraocular lens (IOL) compared to patients with a spherical IOL. PATIENTS AND METHODS: Twenty patients undergoing cataract surgery were divided into two groups according to the type of IOL: ten prolate aspherical IOLs (TECNIS Z9000, AMO, USA) and ten spherical IOLs (911 CeeOn Edge, AMO, USA). The integrity of ocular functions was assessed with clinical examination and multifocal electroretinogram. Contrast sensitivities were tested preoperatively in photopic, mesopic, and glared conditions. Postoperative examinations included refractive evaluation before and after mydriasis, pupil diameter, contrast sensitivities, and wavefront aberration analysis. RESULTS: Postoperative best-corrected visual acuity was 0.95 +/- 0.13 for the TECNIS group vs 0.98 +/- 0.11 for the 911 group (p=0.32). Refractive evaluation revealed mydriasis myopic shift in patients with the 911 IOL (- 0.10+/-0.30 D for the TECNIS group vs - 0.68+/-0.21 D for the 911 group, p=0.002). Mesopic contrast sensitivity was improved in the TECNIS group regarding medium and high spatial frequencies (p=0.003 and p=0.002, respectively), whereas photopic and glared contrast sensitivities were equal in both groups. RMS for high-order aberrations was 0.36 +/- 0.07 microm in the TECNIS group vs 0.33 +/- 0.19 microm in the 911 group (p=0.21), and spherical aberration was lower in patients with TECNIS IOL (Z40=0.03+/-0.06 microm vs 0.20+/-0.14 microm, for the TECNIS group and the 911 group, respectively, p=0.029). CONCLUSION: Combining contrast sensitivities and wavefront aberration analysis provided an objective assessment of the quality of vision in pseudophakic patients. Using prolate aspherical IOL could reduce spherical aberration and improve visual acuity, especially in mesopic conditions.

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Eur J Ophthalmol. 2006 Jan-Feb;16(1):33-9.
Accommodative intraocular lenses: Short-term visual results of two different lens types.
Buratto L, Di Meglio G.
Centro Ambrosiano di Microchirurgia Oculare, Milano - Italy.

PURPOSE. To compare the ability of two types of accommodative intraocular lenses (IOLs) to provide uncorrected near and distance visual acuity (VA) after cataract surgery. METHODS. A total of 108 eyes of 75 patients underwent cataract surgery by phacoemulsification and IOL implantation either bilaterally or monocularly with one of two types of accommodative IOLs: the AT-45 lens (69 eyes) or the 1-CU lens (39 eyes). Patients were followed for up to 1 year after cataract surgery. Near VA was measured through the distance correction to obtain the true near vision effect of the accommodating IOL. RESULTS. Uncorrected distance VA of 20/30 or better was achieved by 84.6% of the bilaterally implanted 1-CU patients and 73.6% of the bilaterally implanted AT-45 IOL patients 1 year following surgery. Uncorrected near VA of J1 or better was achieved by 42% of the patients with the bilateral 1-CU implant and 36.8% of the patients with the bilateral AT-45 implant. For J3 or better near acuity, the values were 92.3% for the bilateral 1-CU patients and 84.2% for the bilateral AT-45 patients at 1 year. A total of 54% of the eyes with 1-CU implants underwent a mild myopic shift (<1.0 D), 21% had a mild hyperopic shift, and 45% of the eyes were emmetropic at 1 year. CONCLUSIONS. Both accommodative IOLs provided good near and distance vision postoperatively. The 1-CU IOL appears clinically to provide slightly better uncorrected distance and distance-corrected near VA than the AT-45 lens. (Eur J Ophthalmol 2006; 15: 33-39).

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J Cataract Refract Surg. 2006 Jan;32(1):85-90.
Phacoemulsification and intraocular lens implantation for acute angle closure not treated or previously treated by laser iridotomy.
Imaizumi M, Takaki Y, Yamashita H.
>From the Department of Ophthalmology (Imaizumi, Takaki), Oita University Faculty of Medicine, and the Department of Ophthalmology (Imaizumi, Yamashita), Oita Prefectural Hospital, Oita, Japan.

PURPOSE: To determine the effect of phacoemulsification, aspiration, and intraocular lens (IOL) implantation in eyes with acute angle closure or eyes with prior laser iridotomy for acute angle closure. SETTING: Department of Ophthalmology, Oita Prefectural Hospital, Oita, Japan. METHODS: Eighteen eyes with acute angle closure and 8 eyes with cataracts that had a prior acute angle closure treated by laser iridotomy had phacoemulsification, aspiration, and IOL. A third group that had phacoemulsification, aspiration, and IOL for cataracts only served as controls. The preoperative and postoperative intraocular pressures (IOPs), visual acuities, and number of antiglaucoma medications were compared between these 3 groups. RESULTS: The mean IOPs in the eyes with phacoemulsification, aspiration, and IOL alone and the eyes with prior acute angle closure treated by laser iridotomy were decreased significantly after phacoemulsification, aspiration, and IOL. The mean IOPs in the control group also decreased, but not significantly. There was no significant difference in the postoperative IOP between the 3 groups. The postoperative visual acuities were improved significantly in the 3 groups, and the differences in the final visual acuities were not significant. Postoperatively, the antiglaucoma medication was not needed in the phacoemulsification, aspiration, and IOL-alone group, but medication was necessary in eyes treated previously with laser iridotomy. CONCLUSION: Phacoemulsification with IOL implantation lowered IOP, improved visual acuity, and diminished the need for antiglaucoma medication in eyes with acute angle closure and with a prior acute angle closure treated by laser iridotomy.

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J Cataract Refract Surg. 2006 Jan;32(1):60-66.
Recovery of visual and functional disability following cataract surgery in older people: Sunderland Cataract Study.
Gray CS, Karimova G, Hildreth AJ, Crabtree L, Allen D, O'connell JE.
>From the School of Clinical Medical Sciences (Gray, Crabtree, O'Connell), University of Newcastle upon Tyne, Newcastle upon Tyne, Research and Development Department (Karimova, Hildreth), Sunderland Royal Hospital, and Sunderland Cataract Centre (Allen), Sunderland, United Kingdom.

PURPOSE: To examine changes in visual, psychological, and functional disability in older people waiting for cataract extraction and 6 months after surgery. SETTING: Community-based study in Northeast England. METHODS: Participants were 92 patients (mean age 78.1 years +/- 6.5 [SD], 79% female) with age-related cataract. Questionnaires were administered at time of listing for cataract extraction, 2 weeks preoperatively, and 2 and 6 months after surgery to assess visual symptoms and function, anxiety and depression, perceived health status, cognition, and activities of daily living. RESULTS: Mean waiting time was 265 +/- 64.4 days. Forty-six patients had first-eye surgery, 39 had second-eye surgery, and 7 had sequential-eye surgery (both eyes operated on during follow-up). During the waiting period, there were no significant changes in visual symptoms, cognition, or functional abilities. However, perceived health status, anxiety, and depression improved significantly during this time. For first- and second-eye patients, surgery resulted in significant improvements in all questionnaire scores, except activities of daily living. CONCLUSIONS: Despite waiting 9 months for cataract surgery, patients did not decline in visual symptoms, social functioning, or cognition. In first- and second-eye patients, successful cataract extraction resulted in significant gains in visual function, cognition, and emotional and general well-being. The benefits of cataract surgery in older people extended beyond simple measures of visual acuity.

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J Cataract Refract Surg. 2005 Dec;31(12):2329-33.
Results of cataract extraction after implantable contact lens removal.
Bleckmann H, Keuch RJ.
Augenzentrum DRK Kliniken Westend, Affiliated Hospital of the Humbold University Berlin, Berlin, Germany. prof.dr.h.bleckmann@t-online.de

PURPOSE: To evaluate the visual results following insertion of implantable contact lenses (ICLs) in ametropic eyes and the development of subcapsular opacification with visual loss and to examine the anterior capsule, including the subcapsular tissue alteration, by light microscopy. SETTING: Department of Ophthalmology, Schlosspark-Klinik, affiliated hospital of the Charite Berlin, Humbold University, Berlin, Germany. METHODS: A prospective noncomparative interventional case series of anterior subcapsular cataracts in 9 of 127 (7.1%) patient eyes receiving ICLs to correct myopia and hyperopia was studied. The cataracts were phacoemulsified due to visual loss, and an intraocular lens (IOL) was implanted in the bag. After capsulorhexis, the anterior capsule was withdrawn for light microscopy examination. Visual acuity in each eye was measured before and after ICL implantation and before and after cataract extraction. The age range of cataract patients was 39 to 53 years. RESULTS: Implantable contact lens removal and phacoemulsification with IOL implantation for emmetropia resulted in an increased visual acuity compared to initial vision. Four of 28 hyperopic eyes (14.3%) developed subcapsular central opacification after ICL implantation, whereas 5 of 99 myopic patients (5.1%) developed opacifications. CONCLUSIONS: Patients should be informed prior to ICL implantation, there is a possibility of secondary subcapsular cataract formation and vision reduction. Although the posterior chamber inlay as well as the cataract can be removed and better acuity can be restored, a possible complication due to the ICL implantation cannot be avoided and the accommodation in young patients lost.

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J Cataract Refract Surg. 2005 Dec;31(12):2319-23.
Clinical results of the blue-light filtering AcrySof Natural foldable acrylic intraocular lens.
Marshall J, Cionni RJ, Davison J, Ernest P, Lehmann R, Maxwell WA, Solomon K.
Department of Ophthalmology GKT, the Rayne Institute, St. Thomas' Hospital, London, England. june.spacey@kcl.ac.uk

PURPOSE: To verify the safety and effectiveness of the new AcrySof Natural (Alcon Laboratories, Inc.) blue-light filtering intraocular lens (IOL), which was designed to achieve a light-transmission spectrum similar to that of the natural human crystalline lens. SETTING: Multicenter U.S. clinical trial. METHODS: In a prospective randomized patient-masked multicenter study, 150 patients received the AcrySof Natural IOL and 147 patients received the AcrySof single-piece IOL as a control. Patients with bilateral age-related cataracts who were willing and able to wait at least 30 days between cataract procedures and had verified normal preoperative color vision were eligible for the study. Standardized surgery included a 4.0 to 5.0 mm capsulorhexis and phacoemulsification. All lenses were inserted in the capsular bag, with verification of in-the-bag placement of both haptics. In all bilateral implantation cases, the same model IOL was used in each eye. Postoperatively, contrast sensitivity and color perception were measured up to 180 days and up to 1 year (for visual acuity) after implantation. RESULTS: No statistically significant differences were discovered between the 2 patient groups in visual acuity, contrast sensitivity evaluated under mesopic and photopic conditions, or the number of patients who passed the Farnsworth D-15 color perception test. There were no lens-related adverse events in either group. CONCLUSIONS: The blue-light filtering AcrySof Natural IOL was equivalent to the conventional AcrySof lens in terms of postoperative visual performance. Additional long-term clinical studies should show whether the IOL actually provides the theoretical benefits to retinal health.

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Ophthalmologica. 2005 Nov-Dec;219(6):390-3.
A retrospective analysis of five intra-ocular lenses and the predictive value of six different intra-ocular lens power calculation formulas.
Zuidervaart W, Luyten GP.
Department of Ophthalmology, University Medical Centre Leiden, Leiden, The Netherlands.

Purpose: To evaluate the refractive and visual outcome after implantation of five different lenses and to evaluate the accuracy of six different intra-ocular lens (IOL) power formulas. Setting: Department of Ophthalmology, University Medical Centre Rotterdam, The Netherlands. Methods: In total, 288 eyes had cataract surgery with implantation of a polymethylmethacrylate lens (Centra55B) or a foldable silicone lens (AMO SI40, Staar AA, Silens 5, Pliolens). The pre- and postoperative refraction and visual outcome were analysed for all lenses under study. Six different IOL power formulas have been used to compare the accuracy of the predictive refractive outcome. Results: The Staar Plate Haptic lens was found to have the best uncorrected visual acuity (UCVA) compared to the Centra55B, AMO SI40 and the Pliolens. Based on the A constant given by the company, the Pliolens revealed a significant overcorrection and the Staar Plate Haptic lens an undercorrection. The achieved postoperative refraction minus the intended postoperative refraction caused significant myopia with the Pliolens and hyperopia with the Staar Plate Haptic lens. The SRK-T and the Holladay formulas give the best predictive lens calculations in relation to the axial length. Conclusion: The A constant of all lenses has to be adjusted for our institute. Especially the AMO SI40, the Staar AA lens and the Silens 5 showed a remarkable difference compared to the A constant given by the company. All foldable lenses were comparable in their visual outcome. The significantly better UCVA of the Staar Plate Haptic lens can be explained by the emmetropic outcome of the postoperative refraction. Copyright (c) 2005 S. Karger AG, Basel.

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Ann Pharmacother. 2005 Dec;39(12):2065-71. Epub 2005 Nov 15.
Vitamin e supplementation in Alzheimer's disease, Parkinson's disease, tardive dyskinesia, and cataract: part 2.
Pham DQ, Plakogiannis R.
1 Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY; Internal Medicine Pharmacotherapy Specialist, Kings County Hospital Center, Brooklyn.

OBJECTIVE: To review clinical trials evaluating the safety and efficacy of vitamin E supplementation in Alzheimer's disease, Parkinson's disease, tardive dyskinesia, and cataract. DATA SOURCES: Using the MeSH terms alpha-tocopherol, tocopherols, vitamin E, Parkinson disease, tardive dyskinesia, Alzheimer disease, cataract, and clinical trials, a literature review was conducted to identify peer-reviewed articles in MEDLINE (1966-July 2005). STUDY SELECTION AND DATA EXTRACTION: Published materials including original research, review articles, and meta-analyses were reviewed. Only English-language articles and trials that included vitamin E alone or in combination with other vitamins or minerals were reviewed. Emphasis was placed on prospective, randomized, double-blind, placebo-controlled clinical trials. DATA SYNTHESIS: The clinical studies demonstrated contradicting results regarding the benefits of vitamin E in Parkinson's disease, tardive dyskinesia, and cataract. The study reviewed for Alzheimer's disease seemed to show benefit when vitamin E was used; however, the statistical methods employed are questionable. There is enough evidence from large, well-designed studies to discourage the use of vitamin E in Parkinson's disease, cataract, and Alzheimer's disease. We recommend that vitamin E be considered a treatment option in patients with tardive dyskinesia only if they are newly diagnosed. CONCLUSIONS: We encourage patients to supplement with vitamin E-rich foods. The use of a daily multivitamin, which usually contains 30 IU of alpha-tocopherol, may be beneficial; however, we discourage individual vitamin E supplements that usually contain 400 IU of alpha-tocopherol.

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Bull Soc Belge Ophtalmol. 2005;(297):45-57.
Surgical treatment outcomes of congenital and juvenile cataracts.
Casaer P, Casteels I, Foets B.
Department of Ophthalmology, St Rafael UZ, Leuven, Belgium.

PURPOSE: Evaluation of visual outcome after lens aspiration with or without intraocular lens implantation for isolated congenital and juvenile cataract in children aged 6 years and younger. MATERIAL AND METHODS: Retrospective review of 48 children with isolated congenital and juvenile cataract who were surgically treated between January 1993 and December 2002 and had a minimal follow-up of 12 months. RESULTS: In the group of children with unilateral cataract, 33% (3 out of 9 children) of aphakic children and 45.5% (5 out of 11 children) of pseudophakic children attained a final best corrected visual acuity of 20/200 and 20/60 respectively. In the group of children with bilateral involvement, 35% (6 out of 17 children) of aphakic children have a final best corrected visual acuity of 20/30 and 63.7% (7 out of 11 children) of pseudophakic children have a final best corrected visual acuity of 20/25 or more. CONCLUSION: The results of this study emphasize the need for early surgery and good organisation of postsurgical care in patients with pediatric cataract to optimise visual outcome. Furthermore patients with isolated unilateral congenital cataract surgically treated at an average age of 15 months without primary lens implantation and with variable and low compliance have suboptimal results. The effect of early surgery with primary lens implantation on the long term visual outcome in pediatric cataract needs to be further evaluated.

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Eye. 2005 Nov 4; [Epub ahead of print]
Dexamethasone-netilmicin: a new ophthalmic steroid-antibiotic combination. Efficacy and safety after cataract surgery.
Russo S, Papa V, Bella AD, Favero A, Radulescu C, Gafencu O, Carstocea B, Milazzo G.
1Medical Department, SIFI S.p.A., Aci S.Antonio, Italy.

PurposeThe purpose of this study was to evaluate both efficacy and safety of a new ophthalmic steroid-antibiotic fixed combination containing dexamethasone and netilmicin in the postsurgical management of cataract surgery.MethodsIn total, 223 patients were randomly treated with dexamethasone 1 mg/ml plus netilmicin 3 mg/ml (n=148), or dexamethasone 1 mg/ml plus tobramycin 3 mg/ml (n=75, TOBRADEX((R))) four times in a day for 7+/-1 days starting immediately after surgery. Efficacy (anterior chamber (AC) inflammation, conjunctival hyperaemia, corneal and lid oedema, ocular infection, pain, photophobia and tearing) and safety (burning, stinging, blurred vision, intraocular pressure, and visual acuity) were analysed in the operated eye after 1 and 7+/-1 days. A follow-up visit was performed at day 14+/-2. The extent of AC inflammation, measured by slit-lamp according to a standard scoring system, was used as primary efficacy parameter.ResultsAt the primary end point (day 7) both fixed combinations were equally effective in reducing postoperative inflammation. The safety profile of the dexamethasone/netilmicin combination was excellent with no evidence of poor local tolerance or adverse reaction.ConclusionsA new fixed combination of dexamethasone and netilmicin was effective and safe in controlling ocular inflammation after cataract surgery.Eye advance online publication, 4 November 2005; doi:10.1038/sj.eye.6702123.

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Br J Ophthalmol. 2005 Nov;89(11):1420-2.
Non-steroidal anti-inflammatory agents for cystoid macular oedema following cataract surgery: a systematic review.
Sivaprasad S, Bunce C, Wormald R.
Moorfields Eye Hospital, 162 City Road, London EC1V 2PD, UK.

AIM: To examine the effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of cystoid macular oedema (CMO) following cataract surgery. METHODS: Systematic literature review of randomised controlled trials (RCTs) that evaluated the effects of NSAIDs in the treatment of CMO following cataract surgery was done according to the Cochrane Collaboration methodology. RESULTS: Seven trials involving a total of 266 participants were included. Four trials studied the effects of NSAIDs in chronic CMO while the other three trials examined the effect of NSAIDs in acute CMO. Little evidence of effectiveness was found for oral indomethacin and topical fenoprofen for chronic CMO in two small trials. Treatment with topical 0.5% ketorolac for chronic CMO was found to be effective in two trials. Three trials examined the effect of topical NSAIDs on acute CMO. The comparisons among these studies were of a NSAID to placebo, prednisolone or another NSAID. Because of considerable heterogeneity between these study designs, their results were not combined in a meta-analysis. CONCLUSION: A positive effect of topical NSAID (0.5% ketorolac tromethamine ophthalmic solution) on chronic CMO was noted. However, there is not enough evidence to show the effectiveness of NSAIDs in acute CMO following cataract surgery.

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Ophthalmology. 2005 Nov;112(11):1997-2003. Epub 2005 Sep 23.
Outcomes of microincision cataract surgery versus coaxial phacoemulsification.
Alio J, Rodriguez-Prats JL, Galal A, Ramzy M.
Instituto Oftalmologico de Alicante, VISSUM Corp., and Ophthalmology Division, Miguel Hernandez University, Alicante, Spain. jlalio@vissum.com

PURPOSE: To compare outcomes of microincision cataract surgery (MICS) with coaxial phacoemulsification. DESIGN: Prospective randomized consecutive case series. PARTICIPANTS: One hundred eyes of 50 patients with nuclear or corticonuclear cataract (grades 2+ to 4) with Lens Opacities Classification System III. METHODS: One hundred eyes (50 patients) were randomly operated through clear corneal incisions using 2 techniques: coaxial phacoemulsification (50 eyes) and microincision cataract surgery (50 eyes). MAIN OUTCOME MEASURES: Mean phacoemulsification time, total phacoemulsification percent, effective phacoemulsification time (EPT) (calculated by multiplying total phacoemulsification time in seconds by the average power percent used), intraoperative total balanced salt solution (BSS) volume, visual outcome, vectorial astigmatic changes, corneal thickness, endothelial cell count, and anterior chamber flare and cells preoperatively and at 1 day, 1 month, and 3 months. RESULTS: Statistically significant differences were found between MICS and coaxial phacoemulsification regarding mean incision size, mean total phacoemulsification percent, and EPT. There were no significant differences between the techniques regarding the mean percent of endothelial cell loss, anterior chamber cell count and flare, mean phacoemulsification time, pachymetric measures or total BSS volume utilized, or visual outcome. The vectorial astigmatic changes in the MICS group showed a change of < or =0.25 diopters (D) in 35% of the eyes, 0.25 to 0.5 D in 50% of the eyes, and 0.5 to 1.0 D in 15% of the eyes. These changes were induced by the surgery. Vectorial astigmatic changes of >1 D were not observed. In the coaxial phacoemulsification group, vectorial astigmatic changes of <0.25 D were not observed either. Changes of 0.25 to 0.5 D were seen in 20% of the eyes, and changes of 0.5 to 1.0 D were seen in 30%. Fifty percent of the eyes showed changes of >1.0 D. Mean vectorial astigmatic changes were 0.36+/-0.23 D in the MICS group and 1.2+/-0.74 D in the coaxial phacoemulsification group (P<0.001). CONCLUSIONS: Microincision cataract surgery significantly lowered mean phacoemulsification time, mean total phacoemulsification percent, mean EPT, and surgically induced astigmatism when compared with coaxial phacoemulsification.

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Ophthalmology. 2005 Nov;112(11):1992-6. Epub 2005 Sep 23.
Aqueous penetration and biological activity of moxifloxacin 0.5% ophthalmic solution and gatifloxacin 0.3% solution in cataract surgery patients.
Kim DH, Stark WJ, O'Brien TP, Dick JD.
Anterior Segment and Cataract/Refractive Service, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-9238, USA.

PURPOSE: To measure the achievable perioperative aqueous concentration of the commercially available topically administered fourth generation fluoroquinolones, moxifloxacin 0.5% ophthalmic solution, and gatifloxacin 0.3% ophthalmic solution, and to correlate this concentration with the agents' biological efficacy in the aqueous humor of patients undergoing routine cataract surgery. DESIGN: Prospective, randomized, parallel, double-masked, clinical trial. PARTICIPANTS: Fifty patients undergoing cataract extraction. METHODS: Patients (n = 25) were given perioperative topical moxifloxacin 0.5% or topical gatifloxacin 0.3% (n = 25). One drop of antibiotic was administered every 10 minutes for 4 doses beginning 1 hour prior to surgery. Aqueous humor was sampled via paracentesis and antibiotic concentrations were determined using validated high performance liquid chromatography (HPLC) procedures. Dilution analyses were performed to determine the biological efficacy of the agents in the aqueous against Staphylococcus epidermidis, the most common cause of postcataract endophthalmitis. MAIN OUTCOME MEASURES: Aqueous humor antibiotic concentrations were measured using HPLC and microdilution bioassay techniques. Biological activity was measured as minimal inhibitory dilution and minimal bactericidal dilution. RESULTS: Aqueous humor concentrations for moxifloxacin via HPLC analysis were 1.80 (+/-1.21) microg/ml, whereas those for gatifloxacin were 0.48 (+/-0.34) microg/ml. This 3.8-fold difference in aqueous humor antibiotic concentrations was statistically significant (P = 0.00003). Similarly, the biological dilution analysis of the aqueous humor samples showed that moxifloxacin attained an estimated activity of 2.1 microg/ml, whereas the gatifloxacin activity was approximately 0.4 mug/ml, which represented a 4.9-fold difference. CONCLUSIONS: This study demonstrated that after topically administered perioperative antibiotics with cataract surgery, moxifloxacin 0.5% ophthalmic solution achieved a statistically significantly higher concentration in aqueous humor compared with gatifloxacin (P = 0.00003). Results from the broth dilution analysis showed that moxifloxacin 0.5% was biologically more active against S. epidermidis than gatifloxacin 0.3% in aqueous humor after topical application. There were no adverse events reported, and incision wounds healed quickly and as expected.

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Clinics. 2005 Oct;60(5):401-6. Epub 2005 Oct 24.
Second eye cataract surgery: perceptions of a population assisted at a university hospital.
Avakian A, Temporini ER, Kara-Jose N.
Discipline of Ophthalmology, Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo, Brazil. aavakian@uol.com.br

OBJECTIVE: To identify daily life difficulties perceived by patients suffering from senile cataract before and after second eye cataract surgery. METHODS: Longitudinal prospective study with 84 patients consecutively seen within the framework of the Cataract Project, with visual acuity equal to or higher than 20/30 in the pseudophakic eye, and equal to or lower than 20/40 with the best possible optical correction in the cataractous eye. A questionnaire was applied during an interview. RESULTS: Before surgery, 60.7% complained about visual impairment (moderate or marked); after surgery, 92.8% had no difficulty. Routine activities, mobility, and leisure activities were significantly altered after surgery (P =.001). CONCLUSION: According to the patients' perceptions, there was a significant reduction in visual difficulties after second eye cataract surgery.

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J Public Health (Oxf). 2005 Oct 18; [Epub ahead of print]
Comparing outcomes of cataract surgery: challenges and opportunities.
McKee M, Whatling JM, Wilson JL, Vallance-Owen A.
London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.

BACKGROUND: There is an increasing demand for routine assessment of surgical outcomes. However, for assessments to be valid, it is essential to understand the influence of patient characteristics on outcomes. The VF-14 visual function instrument offers a possible means of monitoring outcomes of cataract surgery. This article examines lessons learned in the course of an attempt to do this. METHODS: One thousand and ninety-eight patients (41 per cent male and 59 per cent female) undergoing cataract extraction in 29 private hospitals within the British United Provident Association (BUPA) chain in the United Kingdom completed the VF-14 before and at 4 months following surgery. Outcome was measured in terms of absolute post-operative score achieved. The demographic factors associated with post-operative VF-14 score were examined using multivariate analysis, adjusting for baseline score. RESULTS: Women undergoing cataract extraction had worse pre-operative visual function than men. Post-operative VF-14 score was stable as the age of the patient increased, until age 85, after which it declined. The reduction in final outcome in older people was explained in part by their worse post-operative scores but also was associated with increasing age independent of pre-operative score. CONCLUSION: First, although many patients undergoing cataract extraction at an advanced age will achieve excellent results, older age does reduce the outcome that can be expected. Consequently, comparisons of performance of units or surgeons undertaking cataract surgery must take account of the age spectrum being treated. It is not enough simply to add a health status measure to an existing administrative database. Further research is needed to understand the reasons for the poorer outcomes at older ages, in particular the role of co-existing eye disease and development of data systems must take account of the additional information required to make appropriate adjustments.

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Acta Ophthalmol Scand. 2005 Oct;83(5):561-6.
Phacoemulsification in trabeculectomized eyes.
Ehrnrooth P, Lehto I, Puska P, Laatikainen L.
Department of Ophthalmology, University of Helsinki, Helsinki, Finland. pia.ehrnrooth@sci.fi

PURPOSE: To evaluate retrospectively risk indicators for cataract surgery and the effect of phacoemulsification on intraocular pressure (IOP) control in eyes that have undergone trabeculectomy. METHODS: We undertook a retrospective analysis of 138 eyes with primary open-angle glaucoma (POAG) or exfoliation glaucoma (EG) in 138 consecutive patients over the age of 40 years undergoing trabeculectomy with no antimetabolites performed by one surgeon. Of the 48 eyes (35%) undergoing a cataract operation during the follow-up period of 2-5 years, 46 were included in this analysis. Their IOP, glaucoma medication and best corrected visual acuity (BCVA) before cataract surgery and at the last follow-up were compared. Risk indicators for cataract surgery were analysed. RESULTS: Cataract operations were performed 5.1-58.1 months (median 14.4 months) after trabeculectomy. The mean length of follow-up after cataract surgery was 25.3 months (SD 12.9, median 24.8 months). Before cataract surgery, the mean IOP was 16.2 mmHg (SD 4.9) and the mean number of topical antiglaucoma medicines 0.8 (SD 1.0). At the most recent visit, mean IOP was 17.3 mmHg (SD 6.4) (p = 0.35), and the mean number of medicines was 1.3 (SD 1.1) (p = 0.0007). Of the 22 eyes in which treatment had been categorized as completely successful (IOP < or = 21 mmHg without other therapy) before cataract surgery, 13 (59%) had remained so. The number of failures (IOP > 21 mmHg, or more than one medication needed or further surgery performed) increased from 14 (30%) before surgery to 28 (61%) afterwards. The proportion of failures in the cataract surgery group was twice that in the no cataract surgery group (61% versus 31%). In a proportional hazards regression, only age (73.9 years [SD 9.4] and 68.1 years [SD 9.8] in patients with and without cataract surgery, respectively) proved to be a significant (p = 0.001) indicator for surgery. CONCLUSION: The results of this retrospective study on consecutive clinical cases of trabeculectomy indicate that cataract progression after trabeculectomy is mainly an age-related process. In more than half the eyes with good preoperative IOP control, this good control was maintained after cataract surgery. On the other hand, in some eyes cataract surgery may compromise IOP control even when surgery avoids the area of the bleb.

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Prog Retin Eye Res. 2005 Sep;24(5):587-611. Epub 2005 Mar 29.
Intravitreal triamcinolone acetonide for treatment of intraocular proliferative, exudative, and neovascular diseases.
Jonas JB, Kreissig I, Degenring R.
Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, Ruprecht-Karls-University of Heidelberg, Germany. jost.jonas@augen.ma.uni-heidelberg.de

Within the last three years, triamcinolone acetonide has increasingly been applied intravitreally as treatment option for various intraocular neovascular edematous and proliferative disorders. The best response in terms of gain in visual acuity after the intravitreal injection of triamcinolone acetonide was found in eyes with intraretinal edematous diseases such as diffuse diabetic macular edema, branch retinal vein occlusion, central retinal vein occlusion, and pseudophakic cystoid macular edema. Visual acuity increased and degree of intraocular inflammation decreased in eyes with various types of non-infectious uveitis including acute or chronic sympathetic ophthalmia and Adamantiadis-Behcet's disease. Intravitreal triamcinolone may be useful as angiostatic therapy in eyes with iris neovascularization and proliferative ischemic retinopathies. Possibly, intravitreal triamcinolone may be helpful as adjunct therapy for exudative age-related macular degeneration, possibly in combination with photodynamic therapy. In eyes with chronic, therapy resistant, ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure and may stabilize the eye. The complications of intravitreal triamcinolone therapy include secondary ocular hypertension in about 40% of the eyes injected, cataractogenesis, postoperative infectious and non-infectious endophthalmitis, and pseudo-endophthalmitis. Intravitreal triamcinolone injection can be combined with other intraocular surgeries including cataract surgery. Cataract surgery performed some months after the injection does not show a markedly elevated rate of complications. If vision increases and eventually decreases again after an intravitreal triamcinolone acetonide injection, the injection can be repeated. The duration of the effect of a single intravitreal injection of triamcinolone depended on the dosage given. Given in a dosage of about 20mg to non-vitrectomized eyes, the duration of the effect and of the side-effects was 6-9 months. Intravitreal triamcinolone acetonide may offer a possibility for adjunctive treatment of intraocular edematous and neovascular disorders. One has to take into account the side-effects and the lack of long-term follow-up observations.

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Ophthalmologe. 2005 Aug 24; [Epub ahead of print]
[Cataract extraction including posterior chamber lens implantation into eyes with angle-closure glaucoma.]
[Article in German]
Bleckmann H, Keuch R.
Augenzentrum des DRK-Klinikums Westend, Akademisches Lehrkrankenhaus der Humbold-Universitat, Berlin.

OBJECTIVE: The aim of this study was to compare phacoemulsification in eyes with angle-closure glaucoma to the partner eyes with or without iridectomy or laser iridotomy, respectively.METHODS: Twelve eyes with an elevated intraocular pressure due to an angle closure that were treated by phacoemulsification and IOL implantation were compared with 12 partner eyes with narrow angle and iridectomy or iridotomy without intraocular pressure elevation and cataract extraction. The average follow-up period was 15.7+/-2.1 months.RESULTS: The average intraocular pressure in eyes with angle-closure glaucoma was 54.1+/-14.7 mmHg and in the partner eyes 22.4+/-8.6 mmHg preoperatively. Follow-up pressure was 19.3+/-2.0 mmHg in eyes with angle-closure glaucoma and 18.8+/-1.5 mmHg in the partner eyes.CONCLUSION: Primary cataract extraction including posterior chamber lens implantation into eyes with angle-closure glaucoma reduced intraocular pressure to normal levels, increased visual acuity, and decreased the number of antiglaucomatous drugs. Eyes with angle-closure glaucoma do not respond differently to phacoemulsification and lens implantation compared to eyes with narrow angle without pressure elevation during and after phacoemulsification.

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J Cataract Refract Surg. 2005 Aug;31(8):1549-1556.
Visual outcome of microincision cataract surgery with implantation of an Acri.Smart lens.
Alio JL, Rodriguez-Prats JL, Vianello A, Galal A.
>From the Instituto Oftalmologico de Alicante Vissum Incororation (Alio, Rodriguez-Prats, Vianello, Galal), Refractive Surgery and Cornea Unit, Ophthalmology Department, Miguel Hernandez University, Medical School, Alicante, Spain; Ophthalmological Institute (Vianello), La Sapienza University, Rome, Italy; Research Institute of Ophthalmology (Galal), Cairo, Egypt.

PURPOSE: To evaluate visual and refractive outcome of microincision cataract surgery (MICS) with implantation of an Acri.Smart 48S intraocular lens (IOL) (Acri.Tech) through a sub-1.9 mm incision. SETTING: Vissum/Instituto Oftalmologico de Alicante and Ophthalmology Department, Miguel Hernandez University, Alicante, Spain. METHODS: In this consecutive prospective observational noncomparative clinical trial, 45 eyes were included. Microincision cataract surgery was performed through a 1.9 mm or smaller clear corneal incision using low ultrasound power MICS. The IOL was injected using a hydraulic cartridge and injector. The final size of the clear corneal incision, postoperative uncorrected and best corrected near and distance acuities, lens stability, ease of implantation, rate of posterior capsule opacification (PCO), and complications were reported up to 6 months. RESULTS: The Acri.Smart lens was inserted through mean incision of 1.5 mm +/- 0.3 (SD). The mean uncorrected distance visual acuity improved significantly from 20/100 (0.2 +/- 0.2 decimal value) preoperatively to 20/32 (0.7 +/- 0.3) by the end of 6 months postoperatively (P<.000). The best corrected distance visual acuity improved significantly from 20/50 (0.4 +/- 0.2) preoperatively to 20/25 (0.9 +/- 0.2) after 6 months (P<0.000). The uncorrected near visual acuity at the end of 6 months was 20/32 (0.6 +/- 0.2, P<.000). The mean postoperative spherical equivalent was -1.1 +/- 0.9 diopters (P<.947). The safety index was 2.5 for distance and 1.4 for near. There were no intraoperative or postoperative complications. No eye had a neodymium:YAG laser capsulotomy for PCO or reported undesirable complications at the end of 6 months. CONCLUSIONS: Results show that the Acri.Smart 48S IOL is a safe, effective, and stable lens that could be inserted through sub-1.9 mm incisions. It provided excellent surgical performance, predictability, and some degree of pseudoaccommodation.

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Can J Ophthalmol. 2005 Aug;40(4):454-459.
Secondary intraocular lens implantation of traumatic cataract in open-globe injury.
Chuang LH, Lai CC.

Background: The purpose of this study was to determine the visual outcome and accuracy of biometry in traumatic cataract in open-globe injury. Methods: A clinical retrospective study of 30 consecutive patients treated for ocular penetrating trauma was conducted. Patient demographics, causes of injury, wound categories, timing and procedures of the primary repair, interval of subsequent intraocular lens (IOL) implantation, follow-up, and postoperative complications were recorded. Additionally, binocular biometry was documented. Twenty-six eyes (86.7%) were open-globe injuries occurring in the workplace. All patients received cataract extraction with primary repair of the penetrating wound, 18 eyes (60%) underwent trans pars plana vitrectomy with lensectomy and 12 eyes (40%) underwent lens aspiration or extracapsular cataract extraction. Simultaneously, 16 eyes (53.3%) underwent intraocular foreign body removal. Results: The mean visual improvement after secondary IOL implantation was statistically significant (p = 0.002). Seventeen eyes (56.7%) achieved final best-corrected visual acuity of 20/40 or better. The mean deviation of final refraction and target refraction was &ndash;0.69 +/- 0.56 diopter, and 23 eyes (76.7%) were within 1 diopter based on biometry of the traumatic eye. In 18 eyes (60%), the difference was within 1 diopter according to biometry of the fellow eye. In 5 cases (16.7%), there was no improvement of vision because of central corneal scar, secondary glaucoma, macular pucker, or recurrent retinal detachment. Interpretation: The vision of patients with traumatic cataract in open-globe injury was improved after prompt surgical intervention and subsequent IOL implantation. A minority of patients experienced no change in vision or a deterioration of vision due to irregular astigmatism caused by a corneal wound or variable damage to the posterior segment. Using biometry of the injured eye after primary repair was more accurate than using biometry of the fellow eye to determine the power of the lens for IOL implantation in variable open-globe injury.

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J AAPOS. 2005 Aug;9(4):330-5.
Combined intraocular lens implantation and glaucoma implant (tube shunt) surgery in pediatric patients: a case series.
Tesser R, Hess DB, Freedman SF.
Duke University Eye Center, Durham, North Carolina.

Purpose: We sought to investigate the outcomes of children who underwent simultaneous intraocular lens (IOL) implant and glaucoma implant surgery. Methods: Medical records of all patients who underwent simultaneous IOL implant and glaucoma implant surgery from January 1995 through August 2003 by a single surgeon were reviewed. Criteria for success included intraocular pressure </=22 mm Hg, or judged adequate for glaucoma severity, without vision loss or devastating complication. Results: The study included 9 eyes of 8 children who had a mean age of 7.6 years (range, 1-16) and a mean follow-up time of 21 months (range, 8.5-35 months) after simultaneous IOL (either cataract removal with primary IOL, 2 eyes; or secondary IOL implantation, 7 eyes), and glaucoma implant surgery (6 Baerveldt, 3 Ahmed). The indications for combined surgery fell into 3 basic categories: unilateral aphakia with glaucoma (4/9), anatomical features (such as shallow anterior chamber and/or vitreous in the pupillary plane) making an IOL helpful in positioning the tube away from corneal endothelium and/or vitreous (4/9), and unilateral traumatic cataract (1/9). Mean intraocular pressure for operated eyes was 29 mm Hg (range, 21-44) preoperatively and fell to 17 mm Hg (range, 11-22) at last follow up, P = 0.01. The mean number of glaucoma medications was 3.5 preoperatively (range, 2-5) versus 1.9 (range, 0-4) at last follow-up (p = NS). Complications (n = 5) were varied, only 2 of which required additional surgery. Eighty-nine percent (8/9) of patients met criteria for success at last follow-up. Conclusions: Selected children can do well after combined glaucoma implant and IOL surgery, achieving both satisfactory glaucoma control and stable visual acuity.

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Ophthalmology. 2005 Aug 9; [Epub ahead of print]
Intraocular Lens Implantation after Atopic Cataract Surgery Decreases Incidence of Postoperative Retinal Detachment.
Inoue M, Shinoda K, Ishida S, Uchida A, Kurosaka D, Katsura H, Tsubota K.
Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.

PURPOSE: To investigate the efficacy of intraocular lens (IOL) implantation in reducing the incidence of postoperative retinal detachment after cataract surgery in patients with atopic dermatitis. DESIGN: Retrospective review. PARTICIPANTS: One hundred sixty-nine eyes of 126 patients who underwent cataract surgery for atopic cataract were followed for more than 1 year. None of the eyes previously had a retinal detachment or retinal detachment surgery. METHODS: The eyes were divided into 132 eyes of 95 patients with an IOL implantation (IOL group) and 37 eyes of 31 patients without an IOL implantation (aphakia group). The postoperative visual acuity and incidence of postoperative retinal detachment were compared between the 2 groups. The effects of the location of the causative retinal breaks, intraoperative posterior capsule rupture, and postoperative posterior capsulotomy on the incidence of retinal detachments were evaluated. MAIN OUTCOME MEASURES: The postoperative corrected visual acuity, incidence of postoperative retinal detachment, and influence of intraoperative posterior capsule rupture on the retinal detachment. RESULTS: The final visual acuity was better than or equal to 20/20 in 128 eyes (97.0%) of the IOL group and in 29 eyes (78.4%) of the aphakia group (P = 0.0007). Retinal detachment after an uncomplicated cataract surgery occurred in 3 eyes (2.3%) of the IOL group and in 8 eyes (25.8%) of the aphakia group (P<0.0001, Mantel-Cox). Two of 3 eyes (66.7%) in the IOL group and 1 of 8 eyes (16.7%) in the aphakia group that later developed a retinal detachment had an intraoperative posterior capsule rupture. Posterior capsulotomy by yttrium-aluminum-garnet laser did not seem to alter the incidence of postoperative retinal detachment in either the IOL (2.0%) or the aphakia group (25.0%). CONCLUSIONS: The rate of postoperative retinal detachment in eyes with IOL and no intraoperative posterior capsule rupture seems to be low. Intraocular lens implantation with capsular bag fixation may reduce the incidence of postoperative retinal detachment triggered by lens surgery for atopic cataract.

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Curr Med Res Opin. 2005 Aug;21(8):1291-5.
A clinical comparison of two different prednisolone acetate formulations in patients undergoing cataract surgery.
Gayton JL.
Eyesight Associates, Warner Robins, GA, USA. JLGayton@aol.com

PURPOSE: This study was conducted to evaluate the efficacy of two topical steroid prednisolone preparations (Econopred Plus 1%, prednisolone acetate 1%: EPP; Pred Fortedagger 1%, prednisolone acetate 1%: PF) in reducing postoperative inflammation in cataract patients. METHODS: This was a 4 week, randomized, parallel-group, single-center, active-controlled study. One group of patients received postoperative topical EPP while the other group received postoperative topical PF. Both medications were dosed 4 times per day for 14 days and then BID until the container was empty. Both groups of patients received diclofenac sodium QID for 14 days and hydroxypropyl guar (HP-Guar, Systane) QID for 7 days then PRN (or as directed). The presence of corneal surface keratitis, anterior chamber cells and flare (scales 0-3 for keratitis, 0-5 for cells and 0-4 for flare; 0 = none) was evaluated by slit lamp biomicroscopy. RESULTS: EPP produced significantly lower (P < 0.05) anterior chamber flare scores 14 days following surgery (mean +/- SD: 0.86 +/- 0.53) than PF (1.08 +/- 0.40). Otherwise, there were no differences observed between the 2 treatments with respect to keratitis, anterior chamber flare or cells at postop days 1, 7, or 28. CONCLUSIONS: This comparative trial demonstrated that both formulations of prednisolone acetate 1% have similar efficacy in the treatment of postoperative ophthalmologic inflammation.

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Ophthalmology. 2005 Jul 15; [Epub ahead of print]
Pars Plana Lensectomy and Intraocular Lens Implantation in Pediatric Radiation-Induced Cataracts in Retinoblastoma.
Miller DM, Murray TG, Cicciarelli NL, Capo H, Markoe AM.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida.

OBJECTIVE: To investigate visual outcomes, surgical complications, and tumor recurrence among children with retinoblastoma (RB) undergoing pars plana lensectomy, vitrectomy, and simultaneous intraocular lens insertion for radiation-related cataract secondary to external beam radiotherapy (EBRT). DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: The medical records for all patients treated with pars plana lensectomy, vitrectomy, and posterior chamber intraocular lens implantation for radiation-induced cataract after EBRT for RB at a single institution between January 1, 1990, and December 31, 2000, were reviewed. PARTICIPANTS: The study included 16 eyes of 12 children with Reese-Ellsworth stage V RB. MAIN OUTCOME MEASURES: Visual acuity, surgical and postoperative complications, postoperative refraction, and tumor recurrence. RESULTS: The median age at diagnosis of RB was 6 months (range, 1-49 months). All patients received EBRT as primary treatment and experienced radiation-induced cataracts. The median interval from RB diagnosis to cataract surgery was 42 months (range, 28-95 months). Preoperative mean visual acuity was 20/400, with 12 of 16 eyes (75%) having macular tumor involvement. All patients underwent pars plana lensectomy, vitrectomy, and posterior chamber intraocular lens insertion. Vitreous samples were evaluated by cytopathologic examination, and no viable tumor cells were identified in any of the vitreous specimens. Postoperative complications included transient cystoid macular edema in 5 eyes (31%) and iridocyclitis in 3 eyes (19%). The mean follow-up after cataract surgery was 66 months (range, 30-94 months). Final visual acuity was 20/40 or better in 11 of 16 eyes (69%). No late intraocular recurrence, orbital tumors, or metastatic disease was noted in this study. CONCLUSIONS: Pars plana lensectomy, vitrectomy, and simultaneous intraocular lens implantation is an effective means of managing EBRT-induced cataracts in eyes with previously treated RB. There was no evidence of active tumor in eyes undergoing surgery at least 28 months after the diagnosis and commencement of therapy for RB, and no late intraocular, orbital, or metastatic tumors were detected. Visual acuity was limited by the presence of primary macular tumor pathologic features in a subset of patients, but final vision better than 20/400 may be achieved in these eyes.

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BMC Ophthalmol. 2005 Jun 22;5:15.
The combination of intravitreal triamcinolone and phacoemulsification surgery in patients with diabeticfoveal oedema and cataract.
Habib MS, Cannon PS, Steel DH.
Sunderland Eye Infirmary, Queen Alexandra Road, SR2 9HP, UK. Maged.Habib@chs.northy.nhs.uk

BACKGROUND: The management of diabetic patients with refractory macular oedema or patients with no adequate pre-operative view to administer laser treatment provide a challenge to the ophthalmologist. We wished to assess the use, safety and effect of intravitreal triamcinolone injection at the time of cataract surgery in patients with diabetic foveal oedema and sight limiting lens opacities. METHOD: This was a longitudinal non-randomised prospective pilot study in 18 eyes (12 patients). All patients had visually significant lens opacities and either persistent diabetic foveal oedema unresponsive to laser treatment-group A, or foveal oedema with no adequate pre-operative view for laser treatment- group B. The cataract surgery was carried out under full aseptic technique using a self-sealing temporal incision and a foldable acrylic lens. Intravitreal triamcinolone was given infratemporally pars plana at the completion of the cataract surgery. The patients were reviewed at day 5, 2 weeks, 2 months and then every 3 months as required. The Wilcoxin matched-pairs test was used to assess the significance of the improvement in visual acuity at 2 months. RESULTS: Twelve patients with a total of 18 eyes were included in the study. There were 10 patients (15 eyes) in group A and 3 patients (3 eyes) in group B. Preoperatively 16 of the 18 eyes had a visual acuity of 6/24 or worse. Postoperatively 83% of patients had completely dry foveae at 2 weeks. Best-corrected visual acuities at two months review ranged from 6/6 to CF with 9 eyes (50%) achieving 6/12 or better (7 eyes (47%) in group A and 2 eyes (67%) in group B). Three eyes had no recorded improvement in visual acuity, but no eyes had deterioration in acuity. The improvement in visual acuity was significant at p = 0.001. There were no significant sight threatening complications. CONCLUSION: Intravitreal triamcinolone has been shown to lead to an improvement in macular oedema and visual improvement in diabetic patients not undergoing cataract surgery but has not, to our knowledge, been previously used in a study like this one.We suggest that intravitreal injection at the time of cataract surgery could be carried out safely with encouraging visual outcomes in patients with diabetic foveal oedema and cataract.

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Ophthalmology. 2005 May 6; [Epub ahead of print]
Cataract surgery for residual angle closure after peripheral laser iridotomy.
Nonaka A, Kondo T, Kikuchi M, Yamashiro K, Fujihara M, Iwawaki T, Yamamoto K, Kurimoto Y.
Department of Ophthalmology, Kobe City General Hospital, Kobe, Japan.

PURPOSE: To investigate the frequency of residual angle closure after resolution of pupillary blocking by laser peripheral iridotomy and the effects of subsequent cataract surgery to resolve angle closure completely. DESIGN: Retrospective, consecutive, interventional study. PARTICIPANTS: Among 70 eyes treated with laser iridotomy, 13 with residual angle closure were treated with cataract surgery. METHODS: The provocative test of angle closure by prone position in a dark room for 1 hour was performed; increases in tension of >/=8 mmHg, 6 or 7 mmHg, and </=5 mmHg were considered to be positive, suspected positive, and negative, respectively. Configuration of the anterior chamber was examined using ultrasound biomicroscopy (UBM). MAIN OUTCOME MEASURES: Intraocular pressure (IOP), response to the dark room prone position test, and morphologic analysis by UBM were evaluated before and 3 months after cataract surgery. RESULTS: Residual angle closure after iridotomy was seen in 27 (38.6%) of 70 eyes; this was confirmed functionally by the dark room prone position test and morphologically by UBM. Eyes with IOP of >/=20 mmHg or with a glaucomatous visual field defect before iridotomy had a significantly higher incidence of residual angle closure after iridotomy than eyes without these findings (P<0.05). In all the eyes with residual angle closure after iridotomy, the response to the prone position test became negative after cataract surgery, with significant lowering of IOP (P<0.01). CONCLUSIONS: Residual angle closure after iridotomy was common, especially in eyes with primary angle closure and poorly controlled IOP or glaucomatous optic neuropathy. Cataract surgery was effective to resolve completely the residual angle closure after iridotomy and lower IOP.

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Cornea. 2005 May;24(4):406-9.
Preoperative injection of mitomycin C in combined pterygium and cataract surgery.
Avisar R, Bar S, Weinberger D.
Department of Ophthalmology and External Eye Disease Clinic, Rabin Medical Center, Petah Tiqva, Tel Aviv University, Israel. lavisar@bezeqint.net

PURPOSE: To evaluate the safety and efficacy of a preoperative injection of mitomycin C (MMC) in combined pterygium and cataract surgery. METHODS: This was a prospective, nonrandomized, interventional trial. Thirty-nine patients with cataract and pterygium enrolled in a prospective, nonrandomized trial. All patients underwent combined pterygium and cataract surgery. Twenty-seven received a single 0.1-mL injection of 0.15 mg/mL MMC into the pterygium head 4 weeks before surgery and 12 did not. Patients were followed for 12 to 23 months postoperatively. Recurrence of pterygium, side effects, and complications of MMC were recorded. RESULTS: Recurrent pterygium developed in none of the patients treated with MMC preoperatively and in 5 of the nontreated patients. Two patients in the pretreated group had allergic conjunctivitis immediately after MMC injection. No other local eye complications or adverse systemic reactions were recorded. CONCLUSIONS: Preoperative injection of MMC into the head of the pterygium 4 weeks prior to combined pterygium and cataract surgery resulted in no recurrence and no serious complications up to 12 to 23 months of follow-up postoperatively. This procedure may be recommended to save time and cost and to prevent the possible side effects of MMC when administered topically at the time of cataract surgery. Further follow-up and additional studies will be needed to determine the long-term safety and efficacy.

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Graefes Arch Clin Exp Ophthalmol. 2005 Apr;243(4):321-6. Epub 2004 Oct 29.
Correction of pre-existing astigmatism during cataract surgery: comparison between the effects of opposite clear corneal incisions and a single clear corneal incision.
Ben Simon GJ, Desatnik H.
Goldschleger Eye Institute and Department of Ophthalmology, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel.

BACKGROUND: Opposite clear corneal incisions (OCCIs) have been reported to reduce pre-existing astigmatism (PEA) during cataract surgery. Our goal was to evaluate the effect of OCCIs on correcting PEA in cataract surgery.METHODS: Non-randomized prospective study. Thirty-four patients with PEA of greater than 1.5 diopters (D) underwent clear cornea phacoemulsification cataract extraction with 3.2-mm OCCIs (OCCI group). The control group consisted of 23 successive patients with PEA <1.5 D who underwent cataract extraction without OCCI. Best-corrected visual acuity, keratometry and refraction were recorded for all patients pre-operatively and post-operatively.RESULTS: Using keratometric findings, mean astigmatism correction was 1.3 D (+/-0.9 SD; decreased from 2.6 D pre-operatively to 1.4 D post-operatively) in the OCCI group but only 0.4 D in the control group (P<0.005), 8 months post-operatively. Vector analysis of astigmatism correction showed greater change for OCCI patients (1.8 D vs 1.0 D, P=0.002). Using the Holladay method for calculating surgically induced refractive change (SIRC), the OCCI group showed a higher value of SIRC (-1.6 D vs -0.97 D), but this was not statistically significant. The OCCI patients showed a greater and significant change in refraction spherical equivalent than the controls. No complications related to OCCI or cataract surgery occurred during the follow-up period.CONCLUSIONS: Opposite clear cornea incision seems to be a simple, predictable, safe and effective procedure in reducing pre-existing corneal astigmatism in cataract surgery. It has an enhanced effect in correcting astigmatism compared to a single clear cornea incision when using keratometric findings value but not when using refractive data. Future studies are needed to document the long-term effect of OCCI and to evaluate the correlation between incisions of different size and astigmatism correction.

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Eye. 2005 Apr 22; [Epub ahead of print]
Effect of illumination on visual function after monofocal and multifocal intraocular lens implantation.
Elgohary MA, Beckingsale AB.
[1] 1Ophthalmology Department, Essex County Hospital, Colchester, UK [2] 2University Ophthalmology Hospital, Tanta University Hospitals, Tanta, Egypt.

PURPOSE: To compare best-corrected visual acuity (BCVA) and contrast sensitivity (CS) under different levels of illumination in patients who had monofocal and multifocal intraocular lenses (IOLs) and to establish the effect of different lighting conditions on vision in the two groups of patients. METHODS: We retrospectively reviewed 27 patients who underwent phacoemulsification for age-related cataract and IOL implantation of either monofocal (SI30NB; n=10, 37%) or multifocal (SA40N; n=17, 63%) IOLs. Binocular distance and near BCVA and CS were tested using logMAR and Pelli-Robson charts that were externally illuminated with 20, 200, 400, and 1600 lux, and were compared using repeated-measures analysis of variance. A questionnaire was administered to establish the lighting preference in the two groups and the effect of lighting conditions on their vision. RESULTS: Binocular distance and near BCVA and CS significantly increased with increasing illumination from 20 to 200 lux in the monofocal (mean=0.04 vs -0.07; P=0.006; 0.37 vs 0.26, P=0.002 and 1.47 vs 1.60, P=0.01) as well as in the multifocal group (mean=0.03 vs -0.12, P<0.001; 0.38 vs 0.23, P<0.001 and 1.47 vs 1.61, P=0.002). No significant difference in BCVA or CS was found between the two groups at any of the four illumination levels. Both groups had similar lighting preference, but 43.8% of patients in the multifocal group experienced subjective worsening of their vision in bright outdoor lights. CONCLUSIONS: Distance and near BCVA and CS improve with increasing illumination in patients with monofocal and multifocal IOLs, but remain comparable in the two groups under common levels of indoor illumination. Patients with multifocal IOLs may experience worsening of their vision in bright outdoor lights.Eye advance online publication, 22 April 2005; doi:10.1038/sj.eye.6701820.

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Acta Ophthalmol Scand. 2005 Apr;83(2):176-83.
Clinical outcomes of phacoemulsification cataract surgery in diabetes patients: visual function (VF-14), visual acuity and patient satisfaction.
Mozaffarieh M, Heinzl H, Sacu S, Wedrich A.
Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.

PURPOSE: To evaluate the visual outcomes (visual acuity [VA] and visual function) after phacoemulsification cataract surgery in patients with diabetic retinopathy (DR), and assess patient satisfaction with final surgical outcome. METHODS: This prospective study comprised 74 eyes of 74 patients with different stages of DR. One surgeon (AW) performed all cataract surgery in a standardized fashion. Patients were assessed using the VF-14 (Visual Function-14) questionnaire. The following groups of patients were compared: those with no apparent retinopathy; those with mild non-proliferative DR (NPDR); those with severe NPDR, and those with proliferative DR (PDR). Visual acuity and visual function questionnaire (VF-14) responses were recorded preoperatively and 3 months postoperatively, during which the non-operated fellow eye showed no progression in retinopathy. RESULTS: Improvements in visual outcomes were significantly higher in groups 1 and 2 compared to groups 3 and 4 (Tukey-Kramer, p < 0.001). Comparisons between groups 1, 2 and 3, 4 showed significant differences in improvements in VA (Tukey-Kramer, p < 0.01), yet no statistically significant differences in functional (VF-14) improvements emerged between these groups. CONCLUSIONS: Patients with more advanced levels of DR showed no functional improvements despite improvements in VA. This emphasizes the relevance of patient education prior to surgery. In particular, it should be explained to patients with more advanced DR that, although surgery may be required, their functional improvement may be limited.

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Zhonghua Yan Ke Za Zhi. 2005 Mar;41(3):200-4.
[Long-term follow-up of visual functions after pediatric cataract extraction and intraocular lens implantation.]
[Article in Chinese]
Lai J, Yao K, Sun ZH, Zhang Z, Yang YH.
Eye Center, Second Hospital of Zhejiang University, Hangzhou 310006, China.

OBJECTIVE: To assess the visual acuity and binocular function of children after pediatric cataract extraction and intraocular lens implantation. METHODS: 47 children with 68 eyes (< 13 years old) were included in the study: 12 children with monolateral traumatic cataract, 14 children with monolateral congenital cataract and 21 children with bilateral congenital cataract. Cataract type, cataract extent, age at surgery and presence of strabismus and nystagmus and the best corrected distant visual acuity (BCDVA) before surgery were recorded and as well. In addition, the best corrected near visual acuity (BCNVA) and bionocular function were followed up for an average of (41.3 +/- 12.3) months. Statistical analysis was used to define factors that correlated with achieving good visual acuity and binocular function. RESULTS: BCDVA and BCNVA were 0.5 or better in 34 eyes (50.0%) and a good binocular function was achieved in 18 children (38.3%). Age at surgery, extent of cataract, absence of strabismus and nystagmus were significant for good BCDVA. Age at surgery, absence of strabismus and nystagmus, good BCDVA were significant for good binocular function. CONCLUSIONS: Good visual acuity and binocular function can be achieved after pediatric cataract extraction and intraocular lens implantation. Multiple factors correlated with achieving good visual function such as timing of surgery, type and extent of cataract, absence of strabismus and nystagmus etal.

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Arq Bras Oftalmol. 2005 Feb;68(1):29-35. Epub 2005 Mar 30.
Comparison of PMMA, foldable silicone and foldable acrylic hydrophobic intraocular lenses in combined phacoemulsification and trabeculectomy.
Serpa Junior E, Wishart PK.
Departamento de Glaucoma, Hospital Governador Celso Ramos, Florianopolis, SC.

PURPOSE: To compare the postoperative results of phacotrabeculectomy with implantation of PMMA, foldable silicone or foldable hydrofobic acrylic intraocular lens (IOL). SETTING: Glaucoma unit, The Royal Liverpool University Hospital, Liverpool, United Kingdom. METHODS: We studied a total of 124 eyes of three consecutive groups of patients with glaucoma and cataract that underwent phacotrabeculectomy with implantation of a PMMA (30 eyes), a foldable silicone (57 eyes) or a foldable acrylic (37 eyes) IOL. Postoperative Snellen visual acuity and intraocular pressure (IOP), and early and late complications were assessed. All data were analyzed by means of c(2) test, Fisher's exact test, ANOVA/MANOVA tests or a combination whenever appropriate. RESULTS: In all three groups the early and late mean postoperative IOPs were significantly lower than the preoperative ones (p<0.001), with no intergroup differences (p=0.48). The number of eyes with early postoperative hypertension (IOP>25 mmHg) and hypotony (IOP<7 mmHg) was similar in the three groups (p=0.91 and p=0.92 respectively). All groups showed improvement in mean visual acuity (p<0.001), and the differences among the groups were not significant (p=0.79). By 9-12 months after surgery IOPs lower than 22 mmHg without glaucoma medication were found in 76.9% in the PMMA group, 76.6% in the silicone group and in 76.9% in the acrylic group. At the same interval, best visual acuity of 6/12 or better was attained in 80.8%, 83% and 80.8%, in the PMMA, silicone and acrylic groups respectively. The silicone group had significantly more postoperative fibrin reaction into the anterior chamber (p=0.01) and giant cell deposits on the IOL (p<0.0001) than the PMMA and the acrylic groups. The rate of Yag laser posterior capsulotomy was lower with the acrylic IOL (0%) than with the silicone (12.2%) or PMMA (13.3%) IOLs (p=0.08). CONCLUSION: In patients with glaucoma and cataract, phacotrabeculectomy with PMMA, silicone or acrylic IOL was equally effective in lowering the IOP and improving visual acuity. However, incidence of fibrin reaction and lens deposits was higher in those eyes which received a silicone IOL. The PMMA and the acrylic groups did not differ with respect to postoperative complications, but those eyes with an acrylic IOL had a lower rate of posterior capsule opacification.

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Curr Opin Ophthalmol. 2005 Feb;16(1):44-52.
Surgical strategies in patients with cataract and glaucoma.
Verges C, Cazal J, Lavin C.
Institut Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain.

PURPOSE OF REVIEW: This review analyzes the most relevant studies on current surgical strategies to treat glaucoma patients with cataracts. RECENT FINDINGS: No clear evidence has confirmed better results with trabeculectomy alone compared with phacotrabeculectomy. Recent studies have reported successful outcomes combining deep sclerectomy and two-site phacoemulsification. The phacoemulsification cataract extraction will not vary the intraocular pressure of patients with previous deep sclerectomy. Mitomycin C proved to be effective in maintaining lower pressure levels with the combined surgery technique; however, 5-fluorouracil did not show any improvement. Minimally invasive cataract surgery reduces surgical trauma, making it possible to obtain better results with combined surgery and previous glaucoma surgery. SUMMARY: The surgical strategy decision must be customized to every patient. Only filtering surgeries are recommended in glaucoma patients with incipient cataract. Combined surgical procedures are recommended for progressive or advanced glaucoma. Two-site phacotrabeculectomy with mitomycin C achieves better stabilized results; however, combined phacoemulsification with deep sclerectomy or viscocanalostomy achieves similar results with a lower rate of complications. These promising findings need more study to be confirmed.

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Curr Opin Ophthalmol. 2005 Feb;16(1):33-7.
Multifocal intraocular lenses.
Bellucci R.
Director of the Ophthalmic Unit, Hospital and University of Verona, Italy.

PURPOSE OF REVIEW: Multifocal intraocular lenses (IOLs) are growing in popularity among patients and surgeons, and opened the way to refractive lens exchange. Still they are not used routinely in cataract surgery, for reasons probably connected to the frequently observed reduction in contrast sensitivity. Recent papers with clinical study outcomes can help in understanding the advantages and the limits of multifocal IOLs. RECENT FINDINGS: Emerging from every published study, both refractive and diffractive multifocal IOLs usually provide good near visual acuity with distance correction. As many multifocal IOLs are distance-dominant, near vision can be improved by correcting for near the distance focus. The near contrast sensitivity thus obtained is similar to that of monofocal IOLs. Multifocal IOLs have been employed with success in complicated cataract surgery and in trauma cases, with the same outcome as in normal cataract cases. Presbyopic lens exchange remains controversial, with a high success rate in original ametropic eyes, but limited success in original emmetropic eyes. Secondary procedures to improve the refractive outcome are usually of little efficacy in improving patient satisfaction. A new anterior chamber phakic multifocal IOL has been designed to correct presbyopia and small refractive errors. The first clinical results indicate high patient satisfaction, with 7.3% explantation rate. SUMMARY: Multifocal IOLs can be more widely used after cataract surgery, but should be used with caution in almost emmetropic eyes with little or no cataract. Refractive lens exchange with multifocal IOL is especially worthwhile in hyperopic eyes. The new phakic multifocal IOL adds the concept of reversibility to presbyopic lens exchange.

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Curr Opin Ophthalmol. 2005 Feb;16(1):8-26.
Accommodative intraocular lenses: current status.
Dick HB.
Johannes Gutenberg-University, Mainz, Germany.

PURPOSE OF REVIEW: The possibility of using a monofocal IOL with accommodative ability allows refractive cataract surgery with a clearly decreased potential of photic phenomena. Three IOLs of different designs and materials have demonstrated accommodative ability, but the degree of accommodative amplitude has been reported to different extents and variabilities. The plate-haptic CrystaLens has a hinged design that might permit forward movement of the optic as a result of pressure changes in the vitreous cavity. The 1CU has modified haptics that bend in the bag as the lens capsule contracts, which are supposed to cause anterior displacement of the lens optic. With the dual-optic one-piece Synchrony, springlike haptics separate a high-plus anterior lens from a posterior minus lens. With accommodative effort, the capsular bag expands and the springs express kinetic energy, which might allow the optics to separate as the anterior lens moves forward. RECENT FINDINGS: This article seeks to clarify and distinguish the concepts of true accommodation and pseudo accommodation. Current designs of accommodative IOLs are supposed to work by the focus-shift principle to allow true pseudophakic accommodation. Studies that biometrically assessed optic shift found no or only low amplitudes of forward movement. The amount of forward movement, if present, was highly variable between patients. To date, most studies present psychophysical data for the proof of concept, which alone seems insufficient. Capsule bag performance and posterior capsule opacification with accommodative IOLs seem worse than those with standard intraocular lenses. SUMMARY: The potential clinical benefits of accommodative IOL technology for both cataract patients and refractive patients may place accommodative IOLs in a competitive position with multifocal IOL technology.

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Lancet. 2005 Feb 12;365(9459):599-609.
Age-related cataract.
Asbell PA, Dualan I, Mindel J, Brocks D, Ahmad M, Epstein S.
Department of Ophthalmology, Mount Sinai School of Medicine, 1 Gustave L Levy Place, Box 1183, New York, NY 10029, USA.

Cataract, opacification of the lens, is one of the commonest causes of loss of useful vision, with an estimated 16 million people worldwide affected. Several risk factors have been identified in addition to increasing age-genetic composition, exposure to ultraviolet light, and diabetes. However, no method to halt the formation of a cataractous lens has been shown to be effective. Nevertheless, advances in surgical removal of cataracts, including small-incision surgery, use of viscoelastics, and the development of intraocular lenses, have made treatment very effective and visual recovery rapid in most cases. Despite these advances, cataract continues to be a leading public-health issue that will grow in importance as the population increases and life expectancy is extended worldwide.

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Br J Clin Pharmacol. 2005 Feb;59(2):220-6.
Efficacy and safety of three ophthalmic inserts for topical anaesthesia of the cornea. An exploratory comparative dose-ranging, double-blind, randomized trial in healthy volunteers.
Mahe I, Mouly S, Jarrin I, Otero J, Tavera C, Simoneau G, Tillet Y, Conti R, El Meski S, Gaudric A, Bergmann JF.
Unite de Recherches Therapeutiques, Hopital Lariboisiere, 2 Rue A. Pare 75010 Paris, France.

Background Cataract surgery requires prolonged anaesthesia, concomitant with permanent hydration and lubrication of the cornea, in order to provide a clear view of the operation area. Aims The primary objective of the study was to assess several formulae of a soluble ophthalmic insert: TOPICSERT [bupivacaine (Bupi) + hyaluronic acid (HA) or sodium hyaluronate] in terms of complete and long-lasting anaesthesia of the cornea. The hydration properties of HA were not assessed in this study. Methods In a prospective double-blind, cross-over, randomized study, with latin-square allocation of treatments, 16 healthy volunteers received a single dose of each formula (A, 1 mg Bupi and 0.1 mg HA; B, 0.5 mg Bupi and 0.1 mg HA; C, 1 mg Bupi and 0 mg HA, and D acting as a placebo) via the ocular route with 1 week of wash-out between each period. Corneal anaesthesia was measured using a Cochet-Bonnet esthesiometer. Results There was a statistically significant difference between treatments with regard to the main criterion (complete anaesthesia lasting at least 20 min) when general association statistics were used (Mantel-Haenzel test, P < 0.0001): 68.75% (n = 11) of subjects receiving treatment A, 37.5% (n = 6) receiving treatment B, and 87.5% (n = 14) on treatment C reached complete and satisfactory anaesthesia, while this was not achieved in any of the subjects receiving placebo. Ninety-five percent confidence intervals of the difference between treatments were as follows: treatment A vs. B (-0.03, 0.66), treatment A vs. C (-0.47, 0.10), treatment B vs. C (-0.84, - 0.16). Only the difference between B and C was statistically significant (adjusted probability by the method of Bonferroni, P < 0.001). When complete anaesthesia was reached, mean (+/-SD) duration of anaesthesia was as follows: 20.7 (+/-6.5), 15.3 (+/-11.4) and 24.7 (+/-7.6) min for treatments A, B, C, respectively. Conclusions Bupivacaine 1 mg seems to be the efficient and safe dose. The value of hyaluronic acid as a corneal hydration agent and used in association with bupivacaine will be the subject of further studies.

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Klin Monatsbl Augenheilkd. 2005 Jan;222(1):41-5.
[Evaluation of eye patching after cataract surgery in topical anesthesia.]
[Article in German]
Mayer S, Wirbelauer C, Haberle H, Altmeyer M, Pham DT.
Klinik fur Augenheilkunde, Vivantes Klinikum Neukolln, Berlin (Direktor: Prof. D. T. Pham).

BACKGROUND: Although postoperative eye patching is a common practice its background is not well known. Therefore the necessity of eye patching after cataract surgery in topical anesthesia from the medical point of view and the patients' subjective opinion was studied. PATIENTS AND METHODS: In this prospective and randomized study 133 patients received after cataract surgery either no covering of the eye (group1), a transparent eye shield for four hours (group 2), an eye pad for four hours (group 3) or an eye pad until the next morning (group 4). Clinical findings were noted and local symptoms, such as pain, foreign body sensation, tearing and photophobia were documented on a visual analogue scale (0 - 10). Furthermore, a questionnaire concerning the subjective opinion was handed out to the patient. RESULTS: The clinical findings revealed no significant differences between the groups. The mean values for local pain were 0.94 +/- 1.56, for the foreign body sensation 1.41 +/- 2.02, for tearing 0.99 +/- 1.8 and for photophobia 1.05 +/- 1.99. Comparing the groups there was significantly more pain and foreign body sensation reported by the patients in group 3, who received eye patching for 4 hours. 91 % of the unpatched patients had no discomfort, whereas 53 % of the patients wearing an eye pad until the next morning considered it as unnecessary. CONCLUSION: After cataract surgery in topical anesthesia only mild symptoms were noted. There were no significant differences between the groups in the objective clinical findings and the subjective feeling. These results indicate that after cataract surgery eye patching could be unnecessary.

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Curr Med Res Opin. 2004 Dec;20(12):2015-9.
Efficacy of topical ketorolac tromethamine 0.4% for control of pain or discomfort associated with cataract surgery.
Price MO, Price FW.
Cornea Research Foundation of America, and the Price Vision Group, Indianapolis, IN, USA. fprice@pricevisiongroup.net

OBJECTIVE: To evaluate the efficacy of ketorolac 0.4% ophthalmic solution for control of pain and discomfort associated with cataract surgery. METHODS: This was a single-center, double-masked, randomized, fellow-eye placebo-controlled clinical study of 25 patients (mean age 72 years; 76% female) requiring bilateral cataract surgery. Patients received either ketorolac tromethamine 0.4% ophthalmic solution (Acular LS *) or placebo, 1 drop QID for 3 days prior to and 1 day following phacoemulsification and intraocular lens implantation on their first eye, and the other treatment for surgery on the second, fellow eye 1 week-4 weeks later. The physician rated patient cooperation and ocular pain or discomfort during surgery, and patients rated ocular pain or discomfort immediately and 24 h after surgery. RESULTS: Patients reported significantly less ocular pain during the 24 h following surgery when treated with ketorolac 0.4% than with placebo (p = 0.02). Ocular pain was reported for only a single ketorolac 0.4%-treated eye (4%) during that period, compared with 39% of placebo-treated eyes (p = 0.004). No significant differences between eyes treated with ketorolac 0.4% and placebo were observed in patient cooperation, and ocular pain or discomfort during or immediately after surgery. No adverse events occurred during the study. LIMITATIONS: Evaluation of pain is subjective, and the severity of pain experienced in the control, vehicle-treated eyes was low. CONCLUSIONS: The reduction in pain associated with cataract surgery afforded by ophthalmic ketorolac 0.4%, together with its favorable safety profile, make it an important tool to help surgeons meet the high expectations of today's cataract and refractive surgery patients.

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Indian J Ophthalmol. 2004 Dec;52(4):311-7.
Intraoperative performance and longterm outcome of phacoemulsification in age-related cataract.
Dholakia SA, Vasavada AR.
Iladevi Cataract & IOL Research Centre, Ahmedabad, India.

PURPOSE: To evaluate intraoperative performance and longterm surgical outcome after phacoemulsification of age-related cataracts. METHODS: Prospective, observational, non-comparative study of 165 consecutive eyes undergoing phacoemulsification with nuclear sclerosis Grade I to III (Scale I to V). Preoperative evaluation included specular microscopy. Phacoemulsification was performed by a single surgeon using a standardised surgical technique under topical anaesthesia. Intraoperatively, effective phaco time (EPT), wound site thermal injury (WSTI), serious complications (eg. vitreous loss, posterior capsule rupture, zonulolysis) and intraoperative posterior capsule opacification (plaque) were evaluated. Postoperatively, posterior capsule opacification (PCO), Neodymium:YAG (Nd:YAG) laser posterior capsulotomy rate, corneal endothelial count, best corrected visual acuity and cystoid macular oedema were evaluated. Eyes were examined at 6 months and then yearly for 3 years. RESULTS: Mean ages of 78 males and 87 females were 59.12 +/- 8.56 and 58.34 +/- 7.45 years respectively. EPT was 36 +/- 19 seconds and WSTI occurred in 7 eyes (4.7%). No serious intraocular complications occurred. Intraoperative posterior capsule opacification (plaque) was present in 21 eyes (13.93%). Postoperatively, PCO occurred in 8 eyes (4.84%) and Nd:YAG laser posterior capsulotomy was performed in 3 eyes (1.8%). Endothelial cell loss was 7.1% at 3 years follow-up. At the end of 3 years follow-up, 146 eyes (88.89%) maintained a best corrected visual acuity of > or = 6/12. Cystoid macular oedema did not occur in any eye at 1 and 6 months' follow-up. CONCLUSION: PCO rates and endothelial cell loss were acceptable. Consistent and reproducible outcome can be obtained after phacoemulsification of age related cataracts (grade I to III).

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J Glaucoma. 2004 Dec;13(6):510-5.
Contact-topical plus intracameral lidocaine versus peribulbar anesthesia in combined surgery: a randomized clinical trial.
Pablo LE, Ferreras A, Perez-Olivan S, Larrosa JM, Gomez ML, Honrubia FM.
>From the Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain.

PURPOSE:: To compare the efficiency and safety of contact-topical anesthesia versus peribulbar injection anesthesia for phacotrabeculectomy. MATERIALS AND METHODS:: A total of 80 patients undergoing combined cataract and glaucoma surgery were randomly allocated to receive either contact or peribulbar anesthesia. No systemic sedatives were used in either group. Patients were asked to rate their pain level on a 5-point scale for 4 periods: during administration of the anesthetic agent; during surgery; immediately after surgery; and 24 hours postoperatively, while the surgeon recorded his subjective assessment of ease of surgery using a standardized template. The patients' general condition during surgery, as well as the results and short-term complications, were assessed. RESULTS:: The injected anesthesia group showed higher rates of discomfort and pain, and 37 patients reported pain ranging from mild to severe during anesthetic administration. The difference between groups was statistically significant (P < 0.001). During surgery, there were no differences in vital signs, patients' subjective pain evaluation, or surgeon stress. We found no differences between pain rates after surgery. Complications included prolonged chemosis, and we also noted that conjunctival hemorrhage occurred more frequently in the peribulbar group than in the contact anesthesia group. CONCLUSION:: Both anesthetic methods provide high levels of pain control without additional sedation during surgery. The use of contact-topical anesthesia avoids pain and reduces the possibility of complications during administration of anesthetics.

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J Fr Ophtalmol. 2004 Nov;27(9 Pt 1):1017-24.
[Importance of occlusion therapy for amblyopia in partial unilateral congenital cataracts that are discovered late.]
[Article in French]
Denion E, Dedes V, Bonne M, Labalette P, Berger C, Guilbert F, Bouckehove S, Rouland JF.
Service d'Ophtalmologie, Hopital Huriez, CHRU de Lille, avenue Michel Polonovski, 59037 Lille cedex.

PURPOSE: The aim of this study is to investigate the importance of occlusion therapy for amblyopia in patients with partial unilateral congenital cataracts that were discovered after 24 months of age. MATERIAL: and methods: A retrospective study was conducted on 11 patients, each of whom underwent a clinical examination including a cycloplegic refraction with atropine. The average age when the cataract was diagnosed was 35 months. The average distance visual acuity was 6/78 and the average near visual acuity was 35/175. Occlusion therapy using adhesive patches was started after refractive error correction. In two cases, observance was mediocre. RESULTS: Ametropia was found in every patient, with anisometropia in nine patients (alpha<0.02). This anisometropia included an astigmatism that was always greater on the side with the cataract (alpha<0.001), averaging 2.7 diopters. After occlusion therapy for amblyopia, the average visual acuity significantly improved to 6/22 in distance vision (alpha<0.02) and 35/45 in near vision (alpha<0.01). The average follow-up period was 28 months (5-60 months). CONCLUSION: Amblyopia is related to lens opacities as well as frequently associated anisometropia. Functional improvement is greater in near vision than in distance vision. With occlusion therapy for amblyopia, accommodation is preserved. This factor is of utmost importance as near vision is preferential in young children. This study provides an opportunity to recall the importance of refraction and occlusion therapy for amblyopia, which must be systematically attempted in cases of partial unilateral congenital cataracts before considering a surgical procedure.

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Can J Ophthalmol. 2004 Oct;39(6):609-13.
Foldable acrylic versus rigid polymethylmethacrylate intraocular lens in combined phacoemulsification and trabeculectomy.
Alzafiri Y, Harasymowycz P.
Department of Ophthalmology, Maisonneuve-Rosemont Hospital, and the Guy-Bernier Research Centre, Universite de Montreal, Montreal, QC.

BACKGROUND: Combined trabeculectomy and phacoemulsification is a widely accepted option in treating patients with glaucoma who also have cataracts. Implantation of a foldable intraocular lens (IOL) in cataract surgery has several theoretical advantages.We performed a study to determine the results of combined phacoemulsification and trabeculectomy with mitomycin C and implantation of either a foldable acrylic or rigid polymethylmethacrylate (PMMA) IOL. METHODS: Review of the charts of 58 consecutive patients (60 eyes) who underwent combined phacotrabeculectomy for concomitant cataract and glaucoma at a university-affiliated hospital in Montreal between September 2001 and December 2002. Forty-one eyes received a foldable acrylic lens (3.2-mm-wide incision), and 19 eyes received a rigid PMMA lens (5.2-mm-wide incision). Outcome measures included visual acuity, intraocular pressure (IOP) and postoperative complications. The results in the two groups were compared. RESULTS: There were no differences in baseline characteristics between the two groups. Earlier recovery of visual acuity was noted in the foldable IOL group than in the rigid IOL group (p = 0.013 for the difference at day 7). IOP control was similar in the two groups, as was the incidence of IOP spikes in the early postoperative period. INTERPRETATION: The results suggest that combined phacotrabeculectomy with mitomycin C using a foldable acrylic IOL allows for good postoperative IOP control and earlier visual recovery than the same procedure with insertion of a rigid PMMA lens.

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Insight. 2004 Jul-Sep;29(3):10-1.
Topical NSAIDS to control pain in clear corneal cataract extraction.
Goguen ER, Roberts CW.
Weill Medical College of Cornell University, New York, NY 10021, USA.

This study was conducted to assess the additive efficacy of ophthalmic topical nonsteroidal anti-inflammatory drugs (NSAIDs) with topical anesthesia in the control of pain associated with clear corneal cataract extraction. The patients who received three days of preoperative topical NSAIDs had a statistically significant decrease in their level of discomfort. We have previously shown that three days of preoperative NSAIDs can reduce postoperative inflammation after cataract surgery. This study demonstrates that ophthalmic topical NSAIDs also decrease discomfort during surgery.

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Klin Oczna. 2004;106(1-2 Suppl):190-1.
[Phacotrabeculectomy in patients with cataract and chronic open angle glaucoma, and patients with cataract and pseudoexfoliation glaucoma]
[Article in Polish]
Wojcik-Niklewska B, Michalska-Malecka K, Markowska J, Korzekwa W, Romaniuk W.
Oddzialu Klinicznego Chorob Oczu Slaskiej Akademii Medycznej, Wojewodzki Szpital Specjalistyczny nr 5 im. sw. Barbary w Sosnowcu.

PURPOSE: To compare the results obtained after phacotrabeculectomy followed by implantation of an intracapsular lens in patients with cataract and chronic open angle glaucoma, and patients with cataract and pseudoexfoliation open angle glaucoma. MATERIAL AND METHODS: The retrospective study covered 55 eyes with cataract and glaucoma. In 28 eyes, chronic open angle glaucoma was diagnosed, and in 27--pseudoexfoliation glaucoma. In all cases, phacoemulsification of the opacified lens was carried out, a foldable intraocular lens was implanted in the capsule, and the trabeculum was removed by means of a punch. Visual acuity, intraocular pressure and the ratio of applied anti-glaucoma drugs were subject to the assessment. RESULTS: The observation period was 12 months. Within the COAG patient group, the average visual acuity prior to the surgery was 0.2+/-0.24, and after one year from the surgery it increased to 0.82+/-0.22. For PEX glaucoma patients, the values were respectively 0.3+/-0.25 before the surgery and 0.75+/-0.29 a year after it. Considerable reduction of the intraocular pressure was also achieved: in the COAG patients--from 19.51+/-3.8 mm Hg to 16.6+/-1.6 mm Hg, and in PEX glaucoma patients--from 22.28+/-5.18 mm Hg to 17.6+/-2.33 mm Hg one year after the surgery. Also, the quantity of anti-glaucoma drugs applied in the study groups was significantly reduced. The anti-glaucoma drug ratio in the COAG patients dropped from 1.8 to 0 after the surgery, and in the PEX glaucoma patients--from 2.3 to 0.3. CONCLUSIONS: Phacotrabeculectomy is an efficient and safe surgical method, to be recommended for patients both with primary open angle glaucoma and with pseudoexfoliation glaucoma.

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Ophthalmologe. 2004 Jul;101(7):667-74.
[Combined anterior and posterior segment surgery]
[Article in German]
Mueller AJ, Klinger K, Tribus C, Kampik A.
Augenklinik, Ludwig-Maximilians-Universitat, Munchen.

AIM: The aim of this study was to review the postoperative findings in the anterior segment after primary vitrectomy performed in combination with cataract surgery. PATIENTS AND METHOD: In a retrospective analysis covering the period from August 2000 to March 2002, we identified 513 consecutive operations on the retina and vitreous body performed primarily to correct various retinal diseases in the ophthalmology department of the Ludwig Maximilian University in Munich. Concomitant cataracts present in all cases were also treated in the one session. Measurement parameters of postoperative irritation of the anterior chamber included anterior chamber cells, Tyndall effect, fibrin, intraocular pressure, and synechiae formation. Various influencing factors were compared to the measurement parameters in univariate analysis. RESULTS: Correlations between some influencing factors and various measurement parameters were statistically significant in univariate analysis. This was not, however, the case for any of the factors in multivariate analysis. CONCLUSION: Performance of the combined operation according to our protocol does not entail any single parameter that indicates a risk for increased postoperative irritation of the anterior chamber.

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Br J Ophthalmol. 2004 Jul;88(7):905-10.
Is early surgery for congenital cataract a risk factor for glaucoma?
Vishwanath M, Cheong-Leen R, Taylor D, Russell-Eggitt I, Rahi J.
Visual Science Unit, Institute of Child Health, London, UK.

AIMS: To estimate the risk of aphakic glaucoma after lensectomy for congenital cataract and its association with surgery within the first month of life. METHOD: A retrospective case notes review was conducted of all patients who had lensectomy for congenital cataract during their first year of life at Great Ormond Street Hospital between 1994 and 1997. Patients with pre-existing glaucoma, anterior segment dysgenesis, and Lowe syndrome were excluded. The risk of aphakic glaucoma after surgery was estimated using Kaplan-Meier survival analysis. RESULTS: 80 patients, undergoing 128 lensectomies were eligible. Of these, six patients (nine eyes) were lost to follow up. Based on eye count, the risk of glaucoma by 5 years after lensectomy was 15.6% (95% CI 10.2 to 23.4). Based on patient count, the 5 year risk of glaucoma in at least one eye following bilateral surgery was 25.1% (95% CI 15.1 to 40.0). The incidence of glaucoma remained at a constant level for the first 5 years after surgery. After early bilateral lensectomy, within the first month of life, the 5 year risk of glaucoma in at least one eye was 50% (95% CI 27.8 to 77.1) compared to 14.9% (95% CI 6.5 to 32.1) with surgery performed later (log rank test, p = 0.012). There was no significant difference (Kolmogorov-Smirnov test: unilateral lensectomy p = 0.587, bilateral lensectomy p = 0.369) in 5 year visual outcomes between eyes operated before and after 1 month of age. CONCLUSION: Bilateral lensectomy during the first month of life is associated with a higher risk of subsequent glaucoma than with surgery performed later. The reason for this is unclear but it may be prudent, in bilateral cases, to consider delaying surgery until the infant is 4 weeks old. As the incidence of glaucoma is similar for each year after surgery, long term glaucoma surveillance is mandatory.

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Br J Ophthalmol. 2004 Jun;88(6):746-9.
A prospective, randomised comparison of single and three piece acrylic foldable intraocular lenses.
Nejima R, Miyata K, Honbou M, Tokunaga T, Tanabe T, Sato M, Oshika T.
Miyata Eye Hospital, Miyazaki, Japan.

AIMS: To compare the postoperative performance of single and three piece acrylic foldable intraocular lenses (IOLs). METHODS: 20 patients underwent bilateral cataract surgery with a single piece SA30AL IOL in one eye and a three piece MA30BA IOL in the other eye. The eyes were randomly assigned to either a single or three piece lens. The amount of IOL decentration and tilt, area of anterior capsule opening, and degree of posterior capsule opacification were measured using the Scheimpflug anterior segment analysis system (Nidek EAS-1000). Visual acuity and contrast sensitivity were examined. Measurements were performed by masked examiners before and 1 day, 1 week, 1, 3, 6, and 18 months after surgery. RESULTS: There were no significant differences between the two groups (p>0.05, paired t test) in the amount of IOL decentration, IOL tilt, area of anterior capsule opening, degree of posterior capsule opacification, best corrected visual acuity, and contrast sensitivity throughout the 18 month follow up period. CONCLUSION: The single and three piece acrylic foldable IOLs are equally stable in the eye after surgery.

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Arch Ophthalmol. 2004 May;122(5):695-7.
Changes in astigmatism after congenital cataract surgery and intraocular lens implantation: a comparative study.
Spierer A, Bar-Sela SM.
Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer 52621, Israel. spierera@post.tau.ac.il

OBJECTIVE: To evaluate the postoperative changes in astigmatism in the pseudophakic eyes of children who underwent 1 of 3 different types of surgical incisions for congenital cataract extraction with intraocular lens implantation, and in whom astigmatism of at least 3 diopters (D) was recorded 1 week after the operation. METHODS: We retrospectively reviewed the medical records of all the children in our department who had undergone surgery for nontraumatic cataract between 1992 and 2001. Cataract surgery with intraocular lens implantation was performed using 1 of 3 types of surgical incisions: a limbal incision, a scleral tunnel, or a clear corneal incision allowing the use of a foldable intraocular lens. In 28 children (32 eyes) aged 2 months to 11 years (mean +/- SD, 4.7 +/- 3.4 years), astigmatism of 3 D or more was found when assessed 1 week after surgery. The refraction was measured and recorded again 3 months and 5 months after surgery. The paired t test was used to compare the outcome variables. MAIN OUTCOME MEASURES: Refractive error 1 week, 3 months, and 5 months after surgery. RESULTS: Mean +/- SD astigmatism 1 week postoperatively was 5.8 +/- 2.2 D, 5.1 +/- 2.1 D, and 4.0 +/- 1.3 D in groups 1, 2, and 3, respectively. Thereafter, the astigmatic component of the refractive error underwent a spontaneous decline, reaching mean +/- SD values of 0.9 +/- 1.0 D, 1.6 +/- 1.6 D, and 1.0 +/- 0.8 D, respectively, in the 3 groups 5 months after the operation. The difference between the mean values at 1 week and at 5 months in each group was statistically significant (P <.001 in group 1; P =.01 in group 2; and P<.001 in group 3). CONCLUSION: Children who underwent extraction of congenital cataract and intraocular lens implantation by different surgical techniques showed a significant spontaneous reduction in astigmatism postoperatively.

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Cornea. 2004 May;23(4):377-9.
Cataract extraction following penetrating keratoplasty.
Nagra PK, Rapuano CJ, Laibson PL, Kunimoto DY, Kay M, Cohen EJ.
Cornea Service, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA 19107, USA.

OBJECTIVE: To assess the safety of cataract extraction following penetrating keratoplasty for corneal graft survival and to evaluate visual and refractive outcomes in corneal graft patients undergoing cataract extraction. METHODS: Retrospective chart review of 29 eyes of 24 patients with corneal grafts who underwent cataract extraction from January 1, 1993 to December 31, 2002, followed on the Cornea Service at Wills Eye Hospital. RESULTS: The mean time from penetrating keratoplasty to cataract extraction was 8.4 years (range 2 months to 36 years). Following cataract extraction, the corneal grafts remained clear in all but 1 eye (3%), during an average follow-up time of 44.5 months (range 3-118 months). All of the remaining patients benefited from improved visual acuity, with 15 of 28 patients having a postoperative best-corrected visual acuity of 20/30 or better. Patients also benefited from decreased absolute spherical refractive error, with a preoperative mean value of 6.6 +/- 3.4 D compared with 2.4 +/- 1.6 D postoperatively, while cylindrical refractive error remained relatively stable at 3.2 +/- 2.9 D preoperatively and 2.8 +/- 2.4 postoperatively. The patient who developed graft failure had 3 episodes of preoperative endothelial rejection and a clear corneal graft at the time of cataract surgery. CONCLUSIONS: Cataract surgery following penetrating keratoplasty is a safe and effective procedure, with a low but definite risk of corneal graft failure. In patients with clear grafts and visually significant cataracts, cataract extraction alone is preferred over repeat penetrating keratoplasty and cataract extraction.

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Ophthalmologe. 2004 Apr 2 [Epub ahead of print]
[Results of pars plana lensectomy for childhood cataract]
[Article in German]
Gessner B, Wiese S, Lagreze WA.
Augenklinik, Universitat Freiburg.

BACKGROUND. Pars plana lensectomy with subsequent fitting of contact lenses is the standard procedure for cataracts occurring within the first 2 years of life. We wanted to assess the outcome and complication rate of this procedure. METHODS. Pars plana lensectomy was performed on 29 eyes of 15 children with bilateral as well as 12 eyes with unilateral cataracts. All children were reexamined at an age of at least 3 years. RESULTS. In bilateral cases the mean age at the time of surgery was 4.0 months and mean resulting visual acuity 0.32. After exclusion of three eyes with complications or bad postoperative compliance, we found a statistically significant correlation between age at surgery and visual acuity (r(2)=0.432, p<0.05). Some form of binocular vision was achieved by 40% of the children; 17% developed ocular hypertension and 7% a secondary cataract. In the unilateral cases the mean age at surgery was 3.9 months and the mean resulting visual acuity 0.14. There was no significant correlation between age and visual acuity; 17% gained binocular function and 5% had ocular hypertension. CONCLUSION. Visual function after lensectomy is better in eyes with bilateral cataracts compared to unilateral cataracts. Early surgery as well as adequate orthoptic therapy and compliance with wearing the contact lens are necessary for good outcome.

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Isr Med Assoc J. 2004 Mar;6(3):143-6.
Results of combined surgery by phacoemulsification and vitrectomy.
Pollack A, Landa G, Kleinman G, Katz H, Hauzer D, Bukelman A.
Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel.

BACKGROUND: Eyes scheduled for posterior segment surgery may have cataract, which obscures the visualization of the retina. Surgery may be carried out either by a two-step procedure: i.e., removal of the cataract followed later by posterior segment surgery; or it may be done in a single session: i.e., combined surgery of both the anterior and posterior segments. OBJECTIVE: To evaluate the outcomes of combined surgery by phacoemulsification and vitrectomy. METHODS: We retrospectively reviewed the records of 42 patients with coexisting cataract and vitreoretinal disease who underwent combined surgery by phacoemulsification and pars plana vitrectomy at one session. RESULTS: Indications for surgery were vitreous hemorrhage in 71.4%, retinal detachment in 11.9%, macular hole in 11.9%, and epiretinal membrane in 4.8%. There were no significant intraoperative complications. The main early postsurgical complications were fibrinous formation in 11.9%, elevated intraocular pressure in 23.8%, and recurrent vitreous hemorrhage in 9.5%. There were a few late complications related to phacoemulsification: posterior synechia in 9.5%, posterior capsular opacification in 7.1%, and dislocating intraocular lens in 4.8%. Recurrent retinal detachment occurred in five eyes and rubeoisis iridis in one. Visual acuity was improved in 85.8%, stable in 7.1% and worse in 7.1%. CONCLUSIONS: Phacoemulsification performed at the time of posterior segment surgery enables good visualization during the vitrectomy, facilitates surgery, and is associated with only minor complications. In cases with cataract and vitreoretinal diseases, combined surgery by phacoemulsification and vitrectomy in one session may be considered.

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Eye. 2004 Mar;18(3):278-82.
Five-year change in visual acuity following cataract surgery in an older community: the Blue Mountains Eye Study.
Panchapakesan J, Rochtchina E, Mitchell P.
1Department of Ophthalmology, University of Sydney, Australia.

Aims To assess the change in visual acuity following cataract surgery in the Blue Mountains Eye Study (BMES) population. Change in visual acuity was assessed by age, sex, baseline cataract type, and baseline visual acuity.Methods A 5-year prospective follow-up of the population-based BMES cohort, who were initially examined in 1992. After 5 years, 2335 survivors of 3654 (75.1%) baseline BMES participants were re-examined. Slit-lamp and retro-illumination lens photographs were graded for the presence of incident cataract and evidence of cataract surgery. Visual acuity was measured using a logMAR chart, read at 2.4 m. The main outcome measure was change in the number of logMAR letters correctly identified by eyes that underwent cataract surgery during the 5-year follow-up period.Results In a multiple linear regression model, age (P<0.0001) and early age-related maculopathy (ARM) at baseline (P<0.0001) were found to affect adversely the postoperative visual acuity following the cataract surgery. As expected, eyes with any baseline cataract showed the greatest improvement in visual acuity after cataract surgery (right eyes: mean+/-s.e. change of 3.75+/-1.34 letters; left eyes: mean change+/-s.e. of 6.7+/-0.99 letters). There was also a statistically significant improvement in vision after cataract surgery in eyes with no significant lens opacity graded as present at baseline (right eyes: mean+/-s.e. change of 3.78+/-1.85 letters; left eyes: mean change +/-s.e. of 2.68+/-1.33 letters).Conclusions Age and baseline cataract or ARM status, and baseline visual acuity were determinants of the postoperative visual outcome in older persons who underwent cataract surgery in this community.Eye (2004) 18, 278-282. doi:10.1038/sj.eye.6700641

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Curr Opin Ophthalmol. 2004 Feb;15(1):51-5.
Pharmacologic considerations for cataract surgery.
Tipperman R.
Wills Eye Hospital, Philadelphia, Pennsylvania 19106, USA. rtipperman@mindspring.com

PURPOSE OF REVIEW: A variety of options exist for perioperative, intraoperative, and postoperative medications in cataract surgery. This article reviews some of the more timely literature on "controversial" subjects in this area. RECENT FINDINGS: Recent literature may support the rationale for intracameral vancomycin at the time of cataract surgery. The recently released fluoroquinolones moxifloxacin and gatifloxacin are reviewed in terms of their clinical properties. Pharmacologic adjuncts to surgery are discussed, as is the use of intravitreal triamcinolone both at the time of cataract surgery and postoperatively. SUMMARY: Recent advances in ophthalmic pharmacology should aid the practicing anterior segment surgeon. This may affect preoperative, postoperative, and even intraoperative regimens.

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Curr Opin Ophthalmol. 2004 Feb;15(1):40-3.
AquaLase: a new technology for cataract extraction.
Mackool RJ, Brint SF.
The Mackool Eye Institute, Astoria, New York 11103, USA. mackooleye@aol.com

PURPOSE OF REVIEW: This review describes a completely new technology for removal of the crystalline lens and compares it to currently available instruments. The AquaLase option on the Infiniti Vision System (Alcon Laboratories, Fort Worth, Texas) delivers unique advantages over conventional ultrasound phacoemulsification. RECENT FINDINGS: Incremental improvements have made ultrasonic phacoemulsification safer to the posterior capsule and less likely to create wound burn. AquaLase uses a fundamentally different technology that eliminates the risk of incision burn, is probably less likely to cause posterior capsule rupture than ultrasonic phacoemulsification needles, and is more efficient than laser-based lens removal instruments. SUMMARY: AquaLase is a new technology that offers significant advantages and is likely to find wider application as clinical experience accumulates.

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Curr Opin Ophthalmol. 2004 Feb;15(1):16-21.
Accommodating intraocular lenses.
Doane JF.
Discover Vision Centers, Kansas City, Missouri 64055, USA. jdoane@discovervision.com

PURPOSE OF REVIEW: With the advent of interest in accommodative lenses as a solution for presbyopia and the growing baby-boomer demographic, ophthalmic surgeons will have the opportunity to provide this technology to facilitate near, intermediate, and distance vision for their patients. RECENT FINDINGS: At present, six corporate entities and lens designs are attempting to commercialize accommodative intraocular lens devices. One Food and Drug Administration (FDA) clinical trial has been completed and the first FDA-approved accommodating lens is available. SUMMARY: For the first time, ophthalmic surgeons will be able to provide a full range of visual focus in each eye of a patient to maintain binocular function while also avoiding the unwanted mesopic and scotopic visual disturbances that are experienced with monovision and multifocal lens technologies. Accommodative intraocular lenses could revolutionize not only cataract visual rehabilitation but also the surgical approach to presbyopia.

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Am J Ophthalmol. 2004 Feb;137(2):294-300.
Surgical outcomes of combined phacoemulsification and glaucoma drainage implant surgery for Asian patients with refractory glaucoma with cataract.
Chung AN, Aung T, Wang JC, Chew PT.
Department of Ophthalmology, National University Hospital, Singapore.

PURPOSE: To examine the safety and efficacy of combined phacoemulsification and glaucoma drainage implant surgery in providing reduction of intraocular pressure (IOP) and visual rehabilitation in eyes with refractory glaucoma and cataract. DESIGN: Interventional case series. METHODS: A retrospective chart review was performed on all subjects who underwent combined phacoemulsification with intraocular lens implantation and glaucoma drainage implant surgery by a single surgeon at the National University Hospital, Singapore. The implants used were the 185 mm2 Ahmed glaucoma valve and the 350 mm2 Baerveldt glaucoma implant. In terms of IOP, a complete success was defined as IOP of between 6 to 21 mm Hg without medication, qualified success as IOP between 6 to 21 mm Hg with one or more medication, and failure as a sustained IOP of >21 mm Hg or <6 mm Hg with or without one or more medication on two or more visits. RESULTS: A total of 32 combined phacoemulsification and glaucoma implant surgeries in 32 patients was performed. All patients were of Asian origin, and the mean age was 58 +/- 16 years (range, 20-78 years). The Baerveldt glaucoma implant and Ahmed glaucoma valve implant were inserted in 16 eyes each. With a mean follow-up of 13 +/- 5 months (range 6 to 22 months), IOP was reduced from a mean of 28.0 +/- 11.5 mm Hg to 15.2 +/- 6.0 mm Hg postoperatively (P <.0001), whereas the number of antiglaucoma medications decreased from a mean of 2.4 +/- 1.4 to.3 +/-.7 (P <.0001) at last follow-up. Overall, there were 24 eyes (75%) that were classified as complete successes, 4 eyes (12.5%) that were qualified successes, and 4 eyes that failed (12.5%). Twenty-three eyes (72%) had improvement of visual acuity, while only one eye had a loss of more than 1 line of Snellen acuity. There was no case that encountered an intraoperative complication, and postoperative complications occurred in 12 eyes (38%), the most common of which was hypotony (in six eyes, 19%). CONCLUSION: For subjects with refractory glaucoma and cataract, combined phacoemulsification and glaucoma drainage implant surgery provide good visual rehabilitation and control of IOP, with low incidence of complications.

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J Pediatr Ophthalmol Strabismus. 2004 Jan-Feb;41(1):35-8.
Changes in astigmatism after congenital cataract surgery and foldable intraocular lens implantation.
Spierer A, Bar-Sela S.
Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.

PURPOSE: To evaluate the changes in astigmatism after cataract extraction and implantation of a foldable intraocular lens (IOL) in children. Only eyes with astigmatism of 3.0 D or more were included in the study. METHODS: The charts of children who had undergone surgery for nontraumatic cataract using a foldable IOL were retrospectively reviewed. In 13 eyes with astigmatism of 3.0 D or more, the refraction was tested and recorded at 1 week, 3 months, and 5 months postoperatively. A paired t test was used to compare the variables. RESULTS: Mean astigmatism 1 week postoperatively was 4.7 +/- 1.9 D (range, 3.0-10.0 D). Thereafter, the astigmatic component of the refractive error underwent a spontaneous steady decline, reaching a mean value of 0.9 +/- 0.9 D (range, 0-2.25 D) 5 months after surgery. The difference between the mean values at 1 week and 5 months was statistically significant (P < .0001). CONCLUSION: Children who underwent congenital cataract surgery and IOL implantation showed a significant spontaneous reduction in astigmatism postoperatively.

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Cochrane Database Syst Rev. 2004;1:CD004242.
Day care versus in-patient surgery for age-related cataract.
Hamed W, Fedorowicz Z.

BACKGROUND: Age-related cataract accounts for more than 40% of cases of blindness in the world with the majority of people who are blind from cataract found in the developing world. With the increased number of people with cataract there is an urgent need for cataract surgery to be made available as a day-care procedure. OBJECTIVES: The objective of this review is to provide reliable evidence regarding the safety, feasibility, effectiveness and cost-effectiveness of cataract extraction performed as day-care versus in-patient procedure. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group trials register) on The Cochrane Library (Issue 4 2002), MEDLINE (1966 to November 2002), EMBASE (1980 to November 2002) and LILACS (November 2002). SELECTION CRITERIA: This review includes randomised controlled trials comparing day-care and in-patient surgery for age-related cataract. The primary outcome was the achievement of a satisfactory visual acuity six weeks after the operation. DATA COLLECTION AND ANALYSIS: Although two trials are included in the review, adequate data were available for only one trial and therefore pooling of data from studies was not attempted. A descriptive summary is presented. MAIN RESULTS: Two trials, involving a total of 1284 people, are included in this review. One trial reported statistically significant differences in early postoperative complication rates in the day-care group, with an increased risk of increased intraocular pressure, which had no clinical relevance to visual outcomes four months postoperatively. The mean change in visual acuity (Snellen lines) of the operated eye four months postoperatively was 4.1 (standard deviation (SD) 2.3) for the day-care group and 4.1 (SD 2.2) for the in-patient group and not statistically significant. The four-month postoperative mean change in quality of life score measured using the VF14 showed minimal differences between the two groups. Costs were 20% more for the in-patient group and this was attributed to higher costs for overnight stay. One study only reported hotel costs for the non-hospitalised participants making aggregation of data on costs impossible. REVIEWER'S CONCLUSIONS: This review provides some evidence that there is a cost saving but no significant difference in outcome or risk of postoperative complications between day-care and in-patient cataract surgery. This is based on one detailed and methodologically sound trial conducted in the developed world. The success, safety and cost-effectiveness of cataract surgery as a day-care procedure appears to be acceptable but additional well-designed trials are required to confirm these perceptions.

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Eur J Ophthalmol. 2004 Jan-Feb;14(1):7-13.
Posterior chamber lens implantation techniques in posterior capsular rupture.
Yilmaz A, Baser Z, Yurdakul NS, Maden A.
Ophthalmology Department, Mersin University, Faculty of Medicine Hospital, Mersin, Turkey. aycayilmaz@yahoo.com

PURPOSE: To evaluate posterior chamber lens implantation techniques and their results in patients in whom posterior capsular rupture and zonular dialysis arose during cataract operation. METHODS: Forty-three cataractous eyes of 43 consecutive patients with complicated cataract operations such as posterior capsular rupture or zonular dialysis were accepted into this prospective study between November 1999 and January 2001. Intraocular lens implantation to ciliary sulcus was achieved without sutures in 19 cases (Group 1), with one suture from 12 o'clock quadrant in 14 cases (Group 2), and with two sutures from 3 to 9 o'clock quadrants in 10 cases (Group 3). Patients were followed up for 3 months after operation and evaluated for best-corrected visual acuity, refractive astigmatism, corneal edema, anterior chamber depth and inflammation, synechia at angle, intraocular pressure, lens tilt and decentration, intraocular hemorrhage, cystoid macular edema, and retinal detachment. RESULTS: There was no difference among groups in best-corrected visual acuity, refractive astigmatism, corneal edema, anterior chamber depth and inflammation, intraocular pressure, lens tilt and decentration, cystoid macular edema, or retinal detachment. Anterior chamber and vitreous hemorrhage and peripheral anterior synechia were significantly higher in Group 3 when compared with Group 1 (p = 0.009, p = 0.009, and p = 0.004). CONCLUSIONS: In all cases with posterior capsular rupture and zonular dialysis, different posterior chamber lens implantation techniques could be performed, beginning with the least invasive procedure suitable for the conditions with the least complications.

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J Cataract Refract Surg. 2004 Jan;30(1):89-94.
Cataract surgery in children with and without retinopathy of prematurity.
Yu YS, Kim SJ, Chang BL.
Department of Ophthalmology, College of Medicine, and Seoul Artificial Eye Center, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea. ysyu@snu.ac.kr

PURPOSE: To report the outcomes of cataract surgery in children born prematurely who had or did not have retinopathy of prematurity (ROP). SETTING: Seoul National University Hospital, Department of Ophthalmology, Seoul, Korea. METHODS: Retrospective studies were conducted by reviewing the charts of 26 eyes of 14 premature infants with or without ROP that had cataract surgery. The patients' preoperative characteristics and postoperative visual outcomes were documented. Cataract surgery consisted of lensectomy, posterior capsulectomy, and anterior vitrectomy in patients younger than 2 years and primary posterior chamber intraocular lens (PC IOL) implantation or secondary PC IOL implantation in those 2 years or older. Postoperative optical correction in those younger than 2 years was by glasses or contact lenses. RESULTS: Eight eyes of 5 patients had acute ROP; 4 eyes had stage 3, 2 had stage 2, and 2 had stage 1. Three eyes had transconjunctival cryotherapy for treatment of threshold ROP. First-eye cataract surgery were performed in children from 0.2 to 5.5 years old (mean 1.5 years) and second-eye surgery, in children from 1.8 to 12.1 years old (mean 4.3 years). Twenty eyes had implantation of a PC IOL. In 1 patient with stage 3+ ROP, Rush (plus) type, both eyes had combined cataract and scleral buckle encircling surgery. The mean follow-up after the last surgery was 1.4 years (0.5 to 3.1 years). At the last examination, the best corrected visual acuity was good fixation or better than 20/80 except in 2 eyes, 1 with esotropia and the other with a dense pupillary membrane. CONCLUSIONS: This is the first report of an encouraging surgical outcome for PC IOL implantation in premature infants with cataract regardless of the presence of ROP. However, if retinopathy is present and has progressed in the cataractous eye of a premature child, careful examination and timely surgical decisions are important.

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Zhejiang Da Xue Xue Bao Yi Xue Ban. 2004 Jan;33(1):73-6.
[Combined surgery for cataract and glaucoma: phacoemulsification, foldable intraocular lens implantation and viscocanalostomy]
[Article in Chinese]
Yao K, Shen-Tu XC, Xu W, Chen PQ.
The Second Affilicated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China.

OBJECTIVE: To assess the outcome of phacoemulsification-intraocular lens (IOL) implantation combined with viscocanalostomy (P-C group), compared with that of phacoemulsification-IOL implantation combined with trabeculectomy (P-T group). METHODS: Combined phacoemulsification with corneal incision, foldable intraocular lens implantation and viscocanalostomy was performed in 21 eyes of 19 cataract patients with primary open-angle glaucoma. All patients were followed up for 3 - 6 months. RESULT: Intraocular pressure (IOP) was significantly lower in both P-C group and P-T group (P=0.000). There was no statistically significant difference between two groups. Visual outcome was similar in both groups. Complications of P-C group included Descemet's membrane puncture in 2 eyes, Schlemm's tube puncture in 2 eyes and IOP spikes in 3 eyes (at 24 hours postoperatively). The P-C group experienced significantly less inflammation than the P-T group. CONCLUSION: Phacoemulsification-IOL implantation combined with viscocanalostomy is a safe and effective surgery, with lower complicatin rate and easier ambulatory care.

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Ophthalmology. 2004 Jan;111(1):75-84.
Vitamin E supplementation and cataract: randomized controlled trial.
McNeil JJ, Robman L, Tikellis G, Sinclair MI, McCarty CA, Taylor HR.
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. john.mcneil@med.monash.edu.au

OBJECTIVE: To determine whether treatment with vitamin E (500 IU daily) reduces either the incidence or rate of progression of age-related cataracts. DESIGN: A prospective, randomized, double-masked, placebo-controlled clinical trial entitled the Vitamin E, Cataract and Age-Related Maculopathy Trial. PARTICIPANTS: Of 1906 screened volunteers, 1193 eligible subjects with early or no cataract, aged 55 to 80 years, were enrolled and followed up for 4 years. INTERVENTION: Subjects were assigned randomly to receive either 500 IU of natural vitamin E in soybean oil encapsulated in gelatin or a placebo with an identical appearance. MAIN OUTCOME MEASURES: The incidence and progression rates of age-related cataract were assessed annually with both clinical lens opacity gradings and computerized analysis of Scheimpflug and retroillumination digital lens images obtained with a Nidek EAS-1000 lens camera. The analysis was undertaken using data from the eye with the more advanced opacity for each type of cataract separately and for any cataract changes in each individual. RESULTS: Overall, 87% of the study population completed the 4 years of follow-up, with 74% of the vitamin E group and 76% of the placebo group continuing on their randomized treatment allocation throughout this time. For cortical cataract, the 4-year cumulative incidence rate was 4.5% among those randomized to vitamin E and 4.8% among those randomized to placebo (P = 0.87). For nuclear cataract, the corresponding rates were 12.9% and 12.1% (P = 0.77). For posterior subcapsular cataract, the rates were 1.7% and 3.5% (P = 0.08), whereas for any of these forms of cataract, they were 17.1% and 16.7%, respectively. Progression of cortical cataract was seen in 16.7% of the vitamin E group and 18.4% of the placebo group (P = 0.76). Corresponding rates for nuclear cataract were 11.4% and 11.9% (P = 0.84), whereas those of any cataract were 16.5% and 16.7%, respectively. There was no difference in the rate of cataract extraction between the 2 groups (P = 0.87). Lens characteristics of the participants withdrawn from the randomized medications were not different from those who continued. CONCLUSIONS: Vitamin E given for 4 years at a dose of 500 IU daily did not reduce the incidence of or progression of nuclear, cortical, or posterior subcapsular cataracts. These findings do not support the use of vitamin E to prevent the development or to slow the progression of age-related cataracts.

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Acta Paediatr. 2003 Dec;92(12):1376-8.
Cataract in children.
Foster A, Gilbert C.
International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK. allenfoster@compuserve.com

Of the estimated 1.4 million children world-wide who are blind, cataract is responsible for an estimated 190,000 (14%). The incidence varies from 1 to 3/10,000 live births or 10 per million of the total population in low-income countries. Early diagnosis, referral and surgery are important in improving results. A recent study from Sweden indicates that examination of babies in maternity wards results in earlier referral compared with well-baby clinics or no formal screening. Conclusion: It is important that standardized protocols be developed and implemented to screen children for ocular anomalies, especially cataract, before discharge from maternity units.

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J Cataract Refract Surg. 2003 Nov;29(11):2155-62.
Combined endoscopic erbium:YAG laser goniopuncture and cataract surgery.
Feltgen N, Mueller H, Ott B, Frenz M, Funk J.
Department of Ophthalmology, Albert-Ludwigs-University Freiburg, Bern, Switzerland.

PURPOSE: To study the safety and efficacy of endoscopic erbium:YAG (Er:YAG) laser goniopuncture combined with cataract surgery to treat glaucoma. SETTING: Department of Ophthalmology, Albert-Ludwigs-University Freiburg, Freiburg, Germany, and Institute of Applied Physics, University of Bern, Bern, Switzerland. METHODS: In this nonrandominized clinical trial, 20 eyes of 20 patients with cataract and glaucoma were treated by combined phacoemulsification and Er:YAG goniopuncture. The primary study endpoints were intraocular pressure (IOP), visual acuity, and number of antiglaucoma drugs 1 year after surgery. Two- and 3-year postoperative data were also measured. This prospective treatment arm was compared to a retrospective inclusion-matched control group treated by cataract surgery alone. RESULTS: The mean IOP dropped by 30% (23.5 mm Hg +/- 3.9 [SD] to 16.3 +/- 2.7 mm Hg) after 12 months in the laser-treated group (P<.0001) and by 9% (19.8 +/- 1.3 mm Hg to 18.1 +/- 1.8 mm Hg) in the control group (P =.12). After 3 years, the mean IOP in the laser group was 15.0 +/- 2.0 mm Hg. The mean number of antiglaucoma drugs needed decreased from 1.6 +/- 0.9 to 0.5 +/- 0.8 in the laser group (P<.0001) and from 1.0 +/- 0.9 to 0.8 +/- 0.9 in the control group (P =.21). Anterior chamber hemorrhage occurred in 12 eyes after laser treatment and resolved within 72 hours in all but 1 patient who was on warfarin sodium (Coumadin) therapy. There were no cases of hypotony in either group. CONCLUSIONS: Endoscopic Er:YAG laser goniopuncture was a successful adjunct to cataract surgery in glaucoma patients. Sustained IOP reduction was achieved with few postoperative complications.

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Ophthalmologe. 2003 Oct;100(10):843-6.
[Primary implantation of posterior chamber lenses after traumatic cataract peneration]
[Article in German]
Weinand F, Plag M, Pavlovic S.
Zentrum fur Augenheilkunde der Universitat Giessen, Giessen. Frank.S.Weinand@augen.med.uni-giessen.de

PURPOSE: To analyze the postoperative outcome and complication rate after phacoemulsification, lens aspiration or lensectomy with primary intraocular lens (IOL) implantation after traumatic cataract penetration. METHODS: We retrospectively reviewed the data of 15 patients who were admitted to our hospital from 1997 to 2001 because of traumatic cataract with corneal laceration with and without intraocular foreign body (IOFB). In all patients phacoemulsification, lens aspiration or lensectomy and primary IOL implantation were performed. Removal of IOFB was performed in 6 patients. RESULTS: The mean follow-up was 19.6 months, 8 eyes (53%) achieved a final visual acuity of 20/40 or better and 12 eyes achieved 20/100 or better final visual acuity. One patient (final visual acuity=1/40) had an additional macular pathology. Due to irregular astigmatism two patients achieved a final vision of less than 20/100. Major causes of limited visual acuity were central corneal scars and in one patient a photopic maculopathy. Four eyes (25%) developed secondary cataract and underwent YAG laser capsulotomy. In one patient PVR retinal detachment had to be treated by pars-plana vitrectomy with silicone oil tamponade. CONCLUSIONS: Primary implantation of posterior chamber lenses after penetrating ocular trauma is associated with a favourable visual outcome and a low rate of postoperative complications.

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Acta Medica (Hradec Kralove). 2003;46(4):189-94.
Changes of visual function and visual ability in daily life following cataract surgery.
Hejcmanova D, Langrova H, Bytton L, Hejcmanova M.
Charles University in Prague, Faculty of Medicine in Hradec Kralove: Department of Ophthalmology, Czech Republic. hejcmanovad@lfhk.cuni.cz

PURPOSE: To examine best corrected visual acuity (BCVA), contrast sensitivity (CS) and functional visual complaints in early cataract and after the cataract surgery. PATIENTS AND METHODS: 53 eyes with early cataract (BCVA 20/30: Snellen charts) were examined before the surgery as well as 12 months after the surgery. BCVA was tested using logMAR chart. CS was examined using VCTS chart in 6 spatial frequencies. Influence of glare was tested using BAT. Patients' subjective visual functions were evaluted using a questionnaire (distance vision, near vision, mesopic vision and glare conditions). 22 subjects were examined as control group. RESULTS: BCVA was 0.52 (0.22-1.05) preoperatively and 0.83 (0.37-1.26) postoperatively. BCVA in patients in both terms was significantly lower compared to the control group. CS in patients before surgery was significantly lower compared to controls, postoperatively improved significantly and was only nonsignificantly lower compared to controls except for the highest spatial frequency. Glare had only nonsignificant influence. The questionnaire scores were correlated with visual performance in both terms. CONCLUSIONS: The significant improvement of both BCVA and CS suggest that cataract surgery improves quality of life in early cataract. Questionnaire should be considered as adjuncts to BCVA and CS in evaluating early cataract.

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Zhonghua Yan Ke Za Zhi. 2003 Oct;39(10):601-4.
[The preliminary study of photolysis for cataract surgery]
[Article in Chinese]
Lin ZD, Feng B, Cheng B, Zou YP.
Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China.

OBJECTIVE: To evaluate the safety and efficiency of Dodick-ARC photolysis machine (a kind of Nd:YAG laser system) in the using of cataract surgery. METHODS: 52 eyes of cataract (fifty-two patients) were undergone photolysis with Dodick-ARC laser system and foldable intraocular lenses (IOLs) implantation. The hardness of nuclei was graded as N(1.0) to N(4.0) of LOCS III classification system. Before and after operations, the intraocular conditions, visual acuity, corneal thickness and operative complications were recorded. The time of follow-ups was more than 6 months. RESULTS: The operations were accomplished in 28 eyes and were changed into Phacoemulsification in 24 eyes. Posterior capsule rupture occurred in 2 cases (3.8%). Severe corneal edema was found in 3 cases (5.8%) that disappeared in 1 to 2 weeks. Preoperative visual acuity was < 0.05 in 19 cases, 0.05 - 0.3 in 28 cases and 0.4 - 0.5 in 5 cases. Postoperative visual acuity was < or = 0.3 in 1 case, 0.4 - 0.5 in 12 cases, 0.6 - 0.9 in 25 cases and > or = 1.0 in 14 cases. The mean values of pachymetry was 0.59 mm preoperatively and 0.60 mm in 3 months postoperatively (P = 0.097). CONCLUSION: Photolysis using Dodick-ARC Nd:YAG laser system is a safe and effective method for cataract surgery. The further improvement of equipment and surgery techniques is needed.

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Epidemiology. 2003 Nov;14(6):707-12.
Sun exposure as a risk factor for nuclear cataract.
Neale RE, Purdie JL, Hirst LW, Green AC.
Population Studies and Human Genetics Division, Queensland Institute of Medical Research, Brisbane, Australia. racheln@qimr.edu.au

BACKGROUND: Cataracts are the leading cause of blindness and visual impairment throughout the world. An association of sun exposure with cortical cataract has been well established, but the association with nuclear cataract remains unclear. METHODS: This case-control study was nested within the Nambour (Australia) Trial of Skin Cancer Prevention conducted between 1992 and 1996. We compared 195 cases who had a nuclear opacity of grade 2.0 or greater with 159 controls. Structured questionnaires were used to ascertain lifetime sun exposure history, eyeglasses and sunglasses use, and potentially confounding variables such as education and smoking. RESULTS: There was a strong positive association of occupational sun exposure between the ages of 20 and 29 years with nuclear cataract (odds ratio = 5.9; 95% confidence interval = 2.1-17.1). Exposure later in life resulted in weaker associations. Wearing sunglasses, particularly during these early years, afforded some protective effect. CONCLUSIONS: This study provides new evidence to support a link between sun exposure and nuclear cataract. Risk was highest among those with high sun exposure at younger ages.

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J Cataract Refract Surg. 2003 Aug;29(8):1569-74.
Posterior capsule opacification: silicone plate-haptic versus AcrySof intraocular lenses.
Abhilakh Missier KA, Nuijts RM, Tjia KF.
Department of Ophthalmology, Academic Hospital Maastricht, Maastricht, The Netherlands. rnu@soog.azn.nl

PURPOSE: To evaluate posterior capsule opacification (PCO) in fellow eyes, 1 receiving a silicone intraocular lens (IOL) and the other, an acrylate IOL. SETTING: Department of Ophthalmology, Isala Clinics, Zwolle, The Netherlands. METHODS: This retrospective study comprised 107 patients (214 eyes). In each patient, 1 eye was randomly selected to have implantation of an acrylate IOL (AcrySof MA30BA or MA60BM, Alcon) and the other eye, a plate-haptic silicone IOL (AA4203VF, Staar). Outcome measures were the total PCO index, percentage of neodymium:YAG (Nd:YAG) capsulotomies performed, and logMAR best corrected visual acuity (BCVA). The follow-up was 3 years. RESULTS: The total PCO index was significantly lower in the AcrySof group than in the plate-haptic silicone group (P<.0001). There was no significant difference in logMAR BCVA between groups (P>.05). The percentage of Nd:YAG laser treatments was significantly lower in the AcrySof group (2.8%) than in the plate-haptic silicone group (23.1%) (P<.05). CONCLUSIONS: There was significantly less PCO and a lower Nd:YAG laser capsulotomy rate after AcrySof IOL implantation than after plate-haptic silicone IOL implantation. These results did not seem to affect the logMAR BCVA as there were no significant differences between groups in this parameter.

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J Cataract Refract Surg. 2003 Aug;29(8):1575-8.
Effect of an acrylic posterior chamber intraocular lens on posterior capsule opacification in cataract patients with associated risk factors.
Kim NJ, Lee JH.
Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.

PURPOSE: To evaluate the effect of an acrylic foldable posterior chamber intraocular lens (PC IOL) on the rate of posterior capsule opacification (PCO) in patients with associated risk factors. SETTING: Department of Ophthalmology, Seoul National University, Seoul, Korea. METHODS: The medical records of 570 patients who had phacoemulsification and foldable PC IOL implantation by the same surgeon from January 1, 1998, to December 31, 1999, were reviewed. Patients with risk factors for PCO (ie, young age, diabetes mellitus) received an acrylic PC IOL to decrease the opacification rate. Their rate was compared to that in patients without associated risk factors who received a foldable silicone PC IOL. RESULTS: In the patients without diabetes mellitus, the PCO rate in patients younger than 60 years with an acrylic PC IOL and in patients older than 60 years with a silicone PC IOL were similar. In patients older than 60 years, the rate of PCO was significantly lower in patients with diabetes mellitus and an acrylic PC IOL than in patients without diabetes mellitus with a silicone foldable PC IOL. CONCLUSIONS: The rate of PCO in patients with risk factors for PCO with an acrylic PC IOL was similar to or lower than that in patients without risk factors with a foldable silicone PC IOL. Therefore, acrylic PC IOLs are preferable, particularly in patients with risk factors for PCO.

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J Cataract Refract Surg. 2003 Aug;29(8):1556-9.
Posterior capsule opacification: comparison of 3 intraocular lenses of different materials and design.
Wejde G, Kugelberg M, Zetterstrom C.
St Erik's Eye Hospital, Stockholm, Sweden. gisela.wejde@sankterik.se

PURPOSE: To compare posterior capsule opacification (PCO) after cataract surgery with implantation of 3 intraocular lenses (IOLs) of different materials and design. SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: In this prospective clinical study, 180 patients had standardized phacoemulsification performed by a single surgeon and were randomized to have implantation of a heparin-surface-modified (HSM) poly(methyl methacrylate) (PMMA) IOL (809C, Pharmacia & Upjohn), a silicone IOL (SI-40NB, Allergan), or an acrylic IOL (AcrySof MA60BM, Alcon). To morphologically evaluate PCO, retroillumination photographs were obtained and analyzed using Evaluation of Posterior Capsule Opacification computer software. The neodymium:YAG (Nd:YAG) capsulotomy rate was recorded. RESULTS: After 2 years, the HSM PMMA IOL group had significantly more PCO than the silicone and AcrySof IOL groups; the silicone group had significantly more PCO than the AcrySof group (P<.05). The Nd:YAG capsulotomy rate was 20% in the HSM PMMA group, 22% in the silicone group, and 8% in the AcrySof group. CONCLUSION: Patients with an AcrySof IOL developed significantly less PCO than those with a silicone or HSM PMMA IOL with a round-edged design.

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J Cataract Refract Surg. 2003 Aug;29(8):1551-5.
Posterior capsule opacification after phacoemulsification: silicone CeeOn Edge versus acrylate AcrySof intraocular lens.
Prosdocimo G, Tassinari G, Sala M, Di Biase A, Toschi PG, Gismondi M, Corbanese U.
Department of Ophthalmology, Hospital of Conegliano, Conegliano, Italy. gprosdocino@ulss7.it

PURPOSE: To compare the rates and morphologic features of posterior capsule opacification (PCO) after small-incision phacoemulsification and in-the-bag implantation of 2 foldable intraocular lenses (IOLs) over an 18-month follow-up. SETTING: Departments of Ophthalmology, Hospital of Conegliano, Conegliano, and Maggiore Hospital of Bologna, Bologna, Italy. METHODS: In an open clinical study, 78 cataract patients were randomly selected to have implantation of a silicone CeeOn Edge (Pharmacia) or acrylate AcrySof (Alcon) IOL after phacoemulsification cataract surgery. All the patients were operated on using a standard technique and in-the-bag IOL implantation. One eye in each patient was studied. Morphologic evaluation of PCO was performed using Evaluation of Posterior Capsule Opacification software. RESULTS: At 18 months in the CeeOn Edge group, 36 eyes (90%) had a clear posterior capsule and 4 (10%) had PCO that did not affect visual acuity. In the AcrySof group, 26 eyes (68%) had a clear posterior capsule, 11 (29%) had PCO that did not affect visual acuity, and 1 (3%) had PCO with a decrease of 2 or more lines of visual acuity that required a neodymium:YAG laser capsulotomy. No eye developed Elschnig pearls or stretched folds in the bag. The postoperative best corrected visual acuity ranged from 0.8 to 1.0 in 96% in the CeeOn Edge group and in 92% in the AcrySof group. No IOL haze or discoloration was observed in the CeeOn Edge group. Mild IOL decentration and tilting occurred in 4 AcrySof eyes; however, no glistenings were found any AcrySof IOL. CONCLUSIONS: Both the CeeOn Edge and AcrySof groups had a low incidence of PCO after an 18-month follow-up. The CeeOn Edge group had significantly less PCO than the AcrySof group. These results confirm that IOLs with square truncated edges create a barrier effect at the optic edge, reducing the overall incidence of PCO.

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Am J Ophthalmol. 2003 Jul;136(1):146-54.
Cataract treatment in the beginning of the 21st century.
Olson RJ, Mamalis N, Werner L, Apple DJ.
Department of Ophthalmology, University of Utah, Salt Lake City, Utah 84132, USA. randall.oslon@hsc.utah.edu

PURPOSE: To describe the principles upon which present day cataract treatment success resides. DESIGN: Literature review and collective experience of the authors. RESULTS: Surgical removal remains the standard treatment for cataract now and in the foreseeable future. Ultrasound cataract removal with a foldable "in-the-bag" intraocular lens with a truncated edge treated for dysphotopsia best correlates with core treatment principles, as we now understand them. Improving refractive results is an important trend. The worldwide burden of this problem is immense. CONCLUSIONS: While results for treatment of cataracts are excellent today, improvements in safety and refraction precision are needed. Other approaches are desperately needed to stem the worldwide tide of cataract related ocular dysfunction.

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Acta Ophthalmol Scand. 2003 Jun;81(3):233-6.
Longterm results of one-site phacotrabeculectomy.
Cagini C, Murdolo P, Gallai R.
Department of Ophthalmology, University of Perugia, Italy. carlocagini@hotmail.com

PURPOSE: To evaluate results of one-site phacotrabeculectomy and intraocular lens (IOL) implantation. METHODS: A retrospective study of a consecutive series of 62 eyes with cataract and glaucoma, which underwent primary one-site phacotrabeculectomy with IOL implantation. Mean follow-up time was 28 +/- 12.3 months (range 12-46 months). RESULTS: Preoperative mean intraocular pressure (IOP) (25.1 +/- 8.6 mmHg) dropped significantly, to 16.4 +/- 1.3 mmHg 1 year after surgery (p < 0.01). Mean logMAR best corrected visual acuity (VA) improved significantly from 0.74 +/- 0.49 to 0.22 +/- 0.28 (p < 0.01). The most common complications were fibrinous exudation (10%) and choroidal detachment (6%). In two eyes (3%) we successfully performed scleral flap revision to achieve IOP control. CONCLUSION: One-site combined surgery was a safe and effective procedure with good IOP control and visual rehabilitation.

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Br J Ophthalmol. 2003 Jun;87(6):667-72.
Extracapsular cataract surgery compared with manual small incision cataract surgery in community eye care setting in western India: a randomised controlled trial.
Gogate PM, Deshpande M, Wormald RP, Deshpande R, Kulkarni SR.
HV Desai Eye Hospital, Pune, India International Center for Eye Health, Institute of Ophthalmology (Associated with Moorfields Eye Hospital), London, UK. parikshitgogate@hotmail.com

AIM: To study "manual small incision cataract surgery (MSICS)" for the rehabilitation of cataract visually impaired and blind patients in community based, high volume, eye hospital setting; to compare the safety and effectiveness of MSICS with conventional extracapsular cataract surgery (ECCE). METHODS: In a single masked randomised controlled clinical trial, 741 patients, aged 40-90 years, with operable cataract were randomly assigned to receive either MSICS or ECCE and operated upon by one of eight participating surgeons. Intraoperative and postoperative complications were graded and scored according to the Oxford Cataract Treatment and Evaluation Team recommendations. The patients were followed up at 1 week, 6 weeks, and 1 year after surgery and their visual acuity recorded. RESULTS: This paper reports outcomes at 1 and 6 weeks. 706 of the 741(95.3%) patients completed the 6 week follow up. 135 of 362 (37.3%) of ECCE group and 165 of 344 (47.9%) of MSICS group had uncorrected visual acuity of 6/18 or better after 6 weeks of follow up. 314 of 362 (86.7%) of ECCE group and 309 of 344 (89.8%) of MSICS group had corrected postoperative vision of 6/18 or better. Four of 362 (1.1%) of ECCE group and six of 344 (1.7%) of MSICS group had corrected postoperative visual acuity less than 6/60. There were no significant differences between the two groups for intraoperative and severe postoperative complications. CONCLUSION: MSICS and ECCE are both safe and effective techniques for treatment of cataract patients in community eye care settings. MSICS needs similar equipment to ECCE, but gives better uncorrected vision.

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Ophthalmologica. 2003 May-Jun;217(3):204-7.
Phacoemulsification and intraocular lens implantation combined with trabeculotomy for open-angle glaucoma and coexisting cataract.
Kubota T, Touguri I, Onizuka N, Matsuura T.
Department of Ophthalmology, National Nagasaki Medical Center, Nagasaki, Japan. kubota@nmc.hosp.go.jp

OBJECTIVE: To study the outcome of phacoemulsification and intraocular lens implantation combined with trabeculotomy. METHODS: We performed trabeculotomy combined with phacoemulsification and foldable lens implantation in 25 eyes with open-angle glaucoma and coexisting cataract in 18 patients. The series comprised 9 males (13 eyes) and 9 females (12 eyes). Mean age of the patients was 73.4 +/- 10.9 years (45-87 years). Mean follow-up period was 14.3 +/- 6.0 months (6-24 months). RESULTS: The preoperative intraocular pressure was 21.4 +/- 3.7 mm Hg. The postoperative intraocular pressure 6 months after the surgery was 12.8 +/- 3.4 mm Hg. A postoperative tension spike (>30 mm Hg) was observed in 2 eyes. Six months after the operation, the intraocular pressure was controlled under 21 mm Hg in all eyes, and under 16 mm Hg in 18 eyes. The medication score (one point per antiglaucomatous medication) was 2.0 +/- 1.6 before the surgery and 0.4 +/- 0.7 after the surgery. The mean refractive error after the operation was -0.8 +/- 0.7 D (range -2.4 to 0 D). The deviation of the actual refractive error from the predicted one was +0.29 +/- 0.54 D (range -0.52 to +1.10 D). CONCLUSION: The outcome of the combined operation for open-angle glaucoma and coexisting cataract was promising. Copyright 2003 S. Karger AG, Basel

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Niger J Med. 2003 Apr-Jun;12(2):81-3.
Visual outcome with +10 diopter sphere correction after intracapsular cataract extraction.
Abdu L, Foster A.
Department of Ophthalmology, Faculty of Medicine, Bayero University, Kano, Nigeria.

BACKGROUND: The aim of curing cataract blindness is to restore the patient's vision after surgery. The aim of the study was to determine the proportion of surgeries done for cataract blind patients and the visual outcome with +10 diopter sphere (DS) aphakic correction in two consecutive years. METHODS: Of the cataract operations done in the years 1995 and 1996, 8-15 cases were selected from each month by proportionate simple random sampling. Thirty-two (32) were excluded for incomplete or missing records. One hundred and eighteen (118) and one hundred (100) patient records were analyzed for 1995 and 1996 respectively. RESULTS: The patients' ages ranged from 40 to 80 years and all had age related cataract. There were 161 males and 57 females. All had intracapsular cataract extraction (ICCE) without intraocular lens implantation. Eighty-nine patients (75%) and seventy-six patients (76%) had their sight restored in 1995 and 1996 respectively. The proportion of surgeries on blind patients' was 31% and 42% respectively. The proportion of those who remained blind after surgery was the same for both years (2%). Using chi-square test, there was a statistically significant difference in the patients' vision status after ICCE with +10 DS correction (995, p = 0.021; 1996, p = 0.017) but no difference in the visual outcome due to gender. [1995, p = 2.09; 1996, p = 1.98 (Yates correction applied)]. CONCLUSION: Intracapsular cataract extraction with +10 DS correction improves the patients vision status and priority must be given to those already blind.

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Cornea. 2003 Apr;22(3):234-8.
Corneal opacity and cataract: triple procedure versus secondary approach.
Shimmura S, Ohashi Y, Shiroma H, Shimazaki J, Tsubota K.
shimmura@tdc.ac.jp

PURPOSE: To determine the efficacy of planned secondary cataract surgery after keratoplasty. METHODS: Twenty patients (22 eyes) with simultaneous corneal pathology and cataract were enrolled in a prospective, interventional, case-matched, nonrandomized comparative trial. Penetrating keratoplasty (PKP) and extracapsular cataract extraction (ECCE) with IOL insertion (triple procedure) were performed in 11 eyes, and planned phacoemulsification (PEA) with IOL insertion after PKP was performed in 11 case-matched eyes. RESULTS: There were 10 eyes (91%) within +/-2.0 D of expected values in the secondary PEA group versus 5 patients (45%) in the triple procedure group. No difference was observed in endothelial cell density after 1-year follow-up. CONCLUSIONS: Planning for secondary PEA in PKP patients with cataracts is a safe and reliable procedure to obtain less post surgical refractive error. Performing a two-stage intervention has no effect on corneal endothelial viability after 1 year.

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J Cataract Refract Surg. 2003 Apr;29(4):729-32.
Low-dose tissue plasminogen activator in the management of anterior chamber fibrin formation.
Georgiadis N, Boboridis K, Halvatzis N, Ziakas N, Moschou V.
Ophthalmology Department, AHEPA University Hospital, Thessaloniki, Greece.

PURPOSE: To investigate the efficacy of tissue plasminogen activator (tPA) in the treatment of severe fibrinous anterior chamber reactions after intraocular surgery. SETTING: Ophthalmology Department, AHEPA University Hospital, Thessaloniki, Greece. METHODS: The study comprised routine surgical and postoperative cases selected in a nonrandomized fashion. Low-dose tPA infusion (0.2 mL of 125 microg/mL) was administered through a side-port in the anterior chamber in 25 patients with recent or long-standing fibrin formation after cataract extraction (n = 13), trabeculectomy (n = 5), combined procedure (n = 5), or penetrating keratoplasty (n = 2). Patients were treated 4 to 25 days postoperatively (mean 7 days). RESULTS: Fibrin lysis was observed 2 to 12 hours after tPA infusion. No hemorrhage or other complications occurred, and no further treatment was necessary in any patient. Three cases of delayed partial fibrin lysis resolved with intense topical steroid treatment. There were no recurrences over the 3-month follow-up. CONCLUSIONS: Low-dose tPA was an effective and safe method for the management of anterior chamber fibrin formation. Treatment was well tolerated and gave excellent results with no complications.

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J Cataract Refract Surg. 2003 Apr;29(4):712-22.
Peripheral corneal relaxing incisions combined with cataract surgery.
Wang L, Misra M, Koch DD.
Cullen Eye Institute, Baylor College of Medicine, Houston, Texas 77030, USA.

PURPOSE: To analyze the effectiveness of peripheral corneal relaxing incisions (PCRIs) in correcting corneal astigmatism during cataract surgery. SETTING: Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. METHODS: In 115 eyes of 94 patients (mean age 69 years +/- 12 [SD]), cataract surgery was combined with PCRIs. The PCRIs were created according to a nomogram based on age and preoperative keratometric astigmatism. Postoperative keratometric astigmatism was measured at 1 day and 1 and 4 months. Vector analyses using the Holladay-Cravy-Koch formula and Alpins method were performed. RESULTS: The PCRIs significantly decreased keratometric astigmatism in patients with preexisting with-the rule (WTR) or against-the-rule (ATR) astigmatism and increased the percentage of the eyes with lower keratometric astigmatism in each group. Four months postoperatively in patients with WTR astigmatism, single and paired 6.0 mm PCRIs induced mean with-the-wound minus against-the-wound changes (WTW-ATW) of -0.55 diopter (D) and -1.18 D, respectively. In eyes with ATR astigmatism, the mean WTW-ATW changes induced by single 4.5 mm, single 6.0 mm, and paired 6.0 mm PCRIs were -2.18 D, -2.02 D, and -2.72 D, respectively. These mean WTW-ATW changes did not significantly regress from 1 day to 4 months postoperatively. CONCLUSIONS: Peripheral corneal relaxing incisions were effective in reducing preexisting astigmatism during cataract surgery. A modified nomogram is proposed. The long-term effect of PCRIs should be evaluated.

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Ophthalmologe. 2003 Mar;100(3):190-6.
[Is a cataract avoidable? Current status with special emphasis on the pathophysiology of oxidative lens damage, nutritional factors, and the ARED study]
[Article in German]
Kottler UB, Dick HB, Augustin AJ.
Augenklinik mit Poliklinik der Johannes Gutenberg-Universitat Mainz. kottler@augen.klinik.uni-mainz.de

The benefit of long-term nutrient intake to reduce the risk of age-related ocular disease such as cataract or macular degeneration is subject to controversy.Conclusions about the benefits and risks of antioxidant supplements can be expected after reviewing the current literature concerning oxidative-induced lens damage and nutritional effects. Identification of influenceable risk factors for senile cataracts could achieve immense economical relevance.In contrast to former longitudinal epidemiological studies, the AREDS report failed to verify protective properties of highly concentrated vitamin supplements on cataract formation. Although there are enough epidemiological indications for reducing the risk of cataracts by the intake of antioxidants, a general recommendation for the use of supplements is untimely or even wrong until stringent evidence of efficacy is provided.The usefulness of cataract prevention is discussed.

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Ophthalmologe. 2003 Mar;100(3):181-9.
[Antioxidant micronutrients and cataract.Review and comparison of the AREDS and REACT
cataract studies]
[Article in German]
Schalch W, Chylack LT.
Roche Vitamins AG, Basel, Switzerland. wolfgang.schalch@roche.com

Age-related cataract remains the major cause of preventable blindness throughout the world. It has long been realized that one of the important etiological factors for this disease is oxidative and in particular photooxidative damage to the lens.Therefore, the antioxidant micronutrients, vitamins C and E and the carotenoids, in particular beta-carotene, have been discussed as factors that could reduce the risk for this disease. The present article reviews what is known about the transport of these substances to the lens, their accumulation, and their concentrations in the lens. Furthermore, the available epidemiological literature is briefly mentioned, but more emphasis has been placed on a description and discussion of major clinical intervention studies. Finally, the design and results of two of those trials using antioxidant micronutrients, the Age-Related Eye Disease Study (AREDS) and the Roche European American Cataract Trial (REACT), are compared. The AREDS trial did show a positive effect only for age-related macular degeneration but not for cataract, while the REACT trial demonstrated a small but statistically significant deceleration of cataract progression. The techniques for following the course of a cataract in the REACT study were more sensitive to subtle changes than those used in the AREDS study, and this may have been one important factor accounting for the differences. The authors' detailed comparison of these studies, however, suggests that even more important may have been the fact that in the REACT study intervention started earlier in the disease process, with higher doses of vitamins C and E and beta-carotene and consequently with larger plasma concentrations of these antioxidant micronutrients. The REACT trial results support the early complementation of a diversified diet with supplements containing vitamins C and E and beta-carotene as well as other carotenoids. The authors also believe that it is reasonable to include these micronutrients in the therapeutic armamentarium of general ophthalmological practice.

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Eur J Ophthalmol. 2003 Mar;13(2):151-4.
Prevention of posterior capsule opacification using capsular tension ring for zonular defects in
cataract surgery.
D'Eliseo D, Pastena B, Longanesi L, Grisanti F, Negrini V.
Ophthalmic Operating Unit, Lugo Hospital, Ravenna, Italy.

PURPOSE: To evaluate the incidence of secondary cataract in phacoemulsification and intraocular lens implantation using a capsular tension ring in case of zonular dehiscence. METHODS: Phacoemulsification using a double capsular tension ring and intraocular lens implantation was done in 65 eyes with cataract and severe zonular weakness. One year after surgery capsular opacities and fibrosis were detected in a double-blind examination. The results were compared with a control group of 36 eyes that did not have a capsular tension ring but had similar surgery. RESULTS: In the group with the capsular tension ring and implantation 7.7% of patients had moderate or severe posterior capsule opacification, compared with 36.1% in the control group. CONCLUSIONS: Capsular tension rings may influence the formation of capsule opacification.

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Ophthalmologe. 2003 Mar;100(3):176-80.
[Cataract prevention. Therapeutic approaches and critical review of current status]
[Article in German]
Wegener A.
Abteilung fur experimentelle Ophthalmologie, Zentrum fur Augenheilkunde des Universitatsklinikums Bonn. a.wegener@uni-bonn.de

Research on the pathophysiology of the lens already in the early days of the last century led to first attempts to clinically influence cataract development with vitamins.More detailed investigation of lens aging and its interaction with internal and external cataract risk factors led to two different therapeutic strategies: (1) compounds or mixtures expected to slow down the aging processes in the lens (food additives) and (2) compounds to reduce or even arrest the effect of a specific harmful factor.Various mixtures expected to influence aging processes were even developed into approved OTC drugs although their effectiveness was never demonstrated. Among those compounds designed to act on a specific pathomechanism, mainly aldose reductase inhibitors were designed and successfully tested in animal studies.None of these,however, could be developed into a market-approved drug.Larger controlled clinical studies have been performed with various compositions of food additives, but also with nonsteroidal anti-inflammatory drugs such as salicylic acid and ibuprofen. None of the clinical trials,however, evidenced any convincing anti-cataract effect of the compounds or mixtures tested such that a successful anti-cataract drug still remains to be developed.

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Nutrition. 2003 Jan;19(1):21-4.
Lutein, but not alpha-tocopherol, supplementation improves visual function in patients with age-related cataracts: a 2-y double-blind, placebo-controlled pilot study.
Olmedilla B, Granado F, Blanco I, Vaquero M.
Unidad de Vitaminas, Seccion de Nutricion, Clinica Puerta de Hierro, Madrid, Spain. bolmedilla@hpth.insalud.es

OBJECTIVE: We investigated the effect of long-term antioxidant supplementation (lutein and alpha-tocopherol) on serum levels and visual performance in patients with cataracts. METHODS: Seventeen patients clinically diagnosed with age-related cataracts were randomized in a double-blind study involving dietary supplementation with lutein (15 mg; n = 5), alpha-tocopherol (100 mg; n = 6), or placebo (n = 6), three times a week for up to 2 y. Serum carotenoid and tocopherol concentrations were determined with quality-controlled high-performance liquid chromatography, and visual performance (visual acuity and glare sensitivity) and biochemical and hematologic indexes were monitored every 3 mo throughout the study. Changes in these parameters were assessed by General Linear Model (GLM) repeated measures analysis. RESULTS: Serum concentrations of lutein and alpha-tocopherol increased with supplementation, although statistical significance was reached only in the lutein group. Visual performance (visual acuity and glare sensitivity) improved in the lutein group, whereas there was a trend toward the maintenance of and decrease in visual acuity with alpha-tocopherol and placebo supplementation, respectively. No significant side effects or changes in biochemical or hematologic profiles were observed in any of the subjects during the study. CONCLUSIONS: Visual function in patients with age-related cataracts who received the lutein supplements improved, suggesting that a higher intake of lutein, through lutein-rich fruit and vegetables or supplements, may have beneficial effects on the visual performance of people with age-related cataracts.

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J Cataract Refract Surg. 2002 Oct;28(10):1770-3.
Pediatric cataract surgery with or without anterior vitrectomy.
Kugelberg M, Zetterstrom C.
St. Erik's Eye Hospital, Stockholm, Sweden. m.kuelberg@sankterik.se

PURPOSE: To evaluate after-cataract formation in children having cataract surgery with or without dry anterior vitrectomy and possible differences according to age. SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: This retrospective study comprised 85 eyes of 85 patients from 0 to 15 years old who had cataract surgery with or without anterior vitrectomy after the implantation of an intraocular lens (IOL). All patients had primary posterior capsulorhexis but no optic capture. Thirty-five patients received a heparin-surface-modified poly(methyl methacrylate) IOL (809C, Pharmacia & Upjohn) and 50 patients, a foldable acrylic IOL (AcrySof(R), Alcon). The records from follow-up visits at the patients' home clinics were used for analysis. RESULTS: Significantly fewer children were operated on for after-cataract if they had cataract surgery with anterior vitrectomy (P <.05). This applied to both IOL types. In the children older than 7 years in the AcrySof IOL group, there was no difference in the frequency of after-cataract surgery (P >.05). CONCLUSION: In children younger than 7 years with an AcrySof IOL, the rate of after-cataract surgery was significantly less in those who had an anterior vitrectomy at the time of cataract surgery (P <.05).In younger children, it is advantageous to perform cataract surgery with anterior vitrectomy to help prevent after-cataract formation; however, vitrectomy is not necessary in older children.

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Zhonghua Yan Ke Za Zhi. 2002 Aug;38(8):488-90.
[Preliminary results of foldable intraocular lens implantation in children with cataract]
[Article in Chinese]
Yao Z, Xie L, Huang Y, Wang Z.
Shandong Eye Institute & Hospital, Qingdao 266071, China.

OBJECTIVE: To evaluate the result of phacoemulsification and foldable intraocular lens implantation (IOL) through a small incision in children with cataract. METHODS: Phacoemulsification with anterior vitrectomy and foldable IOL implantation in the capsular bag was performed in 37 eyes of 28 children aged 3 - 15 years (mean 7 years), including 27 eyes of congenital cataract and 10 eyes of traumatic cataract. The visual acuity, corneal curvature and possible complication were followed up for 10 months (range, 3 - 15 months). RESULT: The best corrected visual acuity (BCVA) of congenital cataract were all >/= 0.1, and 59.3% >/= 0.5. All the BCVA of cases with traumatic cataract >/= 0.3, and 80% >/= 0.5. The surgically induced astigmatism (SIA) was (1.18 +/- 0.65) D, (0.67 +/- 0.59) D and (0.60 +/- 0.39) D in one week, one month, and three months respectively after the operation, and it was stable in the postoperative one month. Secondary cataract occurred in 5 cases (13.5%), and no other complications were found. CONCLUSIONS: Phacoemulsification and foldable IOL implantation through a small incision in children with cataract can reduce early post-operative astigmatism and shorten the period of visual rehabilitation. It is a safe procedure with milder inflammatory reaction and less complication.

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Ophthalmic Res 2002 Jul-Aug;34(4):258-63  
Green tea (Camellia sinensis) protects against selenite-induced oxidative stress in experimental cataractogenesis.
Gupta SK, Halder N, Srivastava S, Trivedi D, Joshi S, Varma SD.
Department of Pharmacology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. skgup@hotmail.com

Cataract is the leading cause of blindness worldwide. It is a multifactorial disease primarily associated with oxidative stress produced by free radicals. The protection offered by various antioxidants in cataract development is well established. Polyphenolic compounds present in green tea (Camellia sinensis) are reported to possess antioxidant property in various pathological conditions. The present study was undertaken to evaluate the anticataract potential of green tea leaf (GTL) extract in the development of lens opacification. Enucleated rat lenses were randomly divided into normal, control and treated groups and incubated for 24 h at 37 degrees C. Oxidative stress was induced by sodium selenite in the culture medium of the two groups (except the normal group). The medium of the treated group was additionally supplemented with GTL extract. After incubation, lenses were subjected to glutathione and malondialdehyde estimation. Enzyme activity of superoxide dismutase, catalase and glutathione peroxidase was also measured in different sets of the experiment. In vivo cataract was induced in 9-day-old rat pups of both control and treated groups by a single subcutaneous injection of sodium selenite. The treated pups were injected GTL extract intraperitoneally prior to selenite challenge and continued for 2 consecutive days thereafter. Cataract incidence was evaluated on 16th postnatal day by slit lamp examination. There was positive modulation of biochemical parameters in the organ culture study. Green tea was also found to reduce the incidence of selenite cataract in vivo. The results suggest that green tea possesses significant anticataract potential and acts primarily by preserving the antioxidant defense system. Copyright 2002 S. Karger AG, Basel

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Curr Opin Ophthalmol 2002 Dec;13(6):419-22
Cataracts associated with systemic disorders and syndromes.
Negahban K, Chern K.
Department of Ophthalmology, Trygve Gundersen Eye Center, Boston University School of Medicine; and Ophthalmic Consultants of Boston, Tufts/New England Medical Center, Boston, Massachusetts, USA.

This review article examines the ophthalmic literature published on cataracts and systemic disease during the past year. Epidemiologically, the association between alcohol consumption and lens opacification is reviewed. Cataracts continue to be strongly associated with systemic diseases such as diabetes mellitus. Clinical, basic science reports and the results of the Blue Mountains Eye Study group on the morphology of diabetes-related cataracts are presented. Patients with neurologic disorders such as Wilson disease may first present with decreased vision and cataracts. Cataracts are now associated with syndromes such as Cohen syndrome, Degos disease, and Dubowitz syndrome. A recent study suggests earlier mortality in middle-age patients undergoing cataract surgery.

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Cesk Slov Oftalmol 2002 Sep;58(5):292-7
[Effect of YAG capsulotomy of secondary cataracts on visual functions]
[Article in Czech]
Langrova H, Hejcmanova D, Peregrin J, Bytton L, Hovorkova M.
Ocni klinika FN, Hradec Kralove. langrovah@lfhk.cuni.cz

1. 20 patients (20 eyes) with secondary cataract and best corrected visual acuity (BCVA) of 20/30 or 20/20 using Snellen charts were examined before Nd-YAG capsulotomy and 14 days postoperatively. 2. Contrast sensitivity (CS) was tested on a computerized system of the Contrast sensitivity 8010 type and on VCTS charts in 6 spatial frequencies, BCVA was measured on the logMAR charts with Landolt rings and influence of glare of 342.6 cd/m2 was tested using Brightness Acuity Tester (BAT). 3. BCVA (without and under glare) in patients before and after YAG capsulotomy was significantly lower compared to the control group (p < 0.001). Postoperative improvement of BCVA was markedly higher on logMAR charts (up to 6.6 standardized lines) than using Snellen charts (1 line). 4. CS (without and under glare) using both methods in patients before and after YAG capsulotomy was significantly lower compared to the control group (p < 0.05 to p < 0.001) in spite of significant improvement postoperatively (p < 0.05 to p < 0.001), first of all at intermediate and high spatial frequencies. 5. Glare had only nonsignificant influence on BCVA and CS in all groups.

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J Cataract Refract Surg 2002 Oct;28(10):1864-8
Cataract surgery after holmium:YAG laser thermal keratoplasty.
Ernest PH.
TLC Eye Care of Michigan, Jackson, Michigan, USA.

A 64-year old man had noncontact holmium:YAG (Ho:YAG) laser thermal keratoplasty (LTK) performed in the left eye on March 10, 1998, and in the right eye on January 11, 1999. The patient achieved 1.3 diopters (D) and 1.4 D of corneal steepening in the right and left eye, respectively, which was the desired amount as his refractive error before Ho:YAG LTK was low. At the 3-month postoperative examination of the left eye, cortical cataracts were observed in both eyes. Approximately 1 year later, bilateral cataract extraction was recommended because of patient-reported decreased vision at distance and near and difficulty with vision in the presence of glare. Cataract surgery and intraocular lens (IOL) implantation was performed in both eyes in August 1999 using the keratotomy readings taken after noncontact Ho:YAG LTK to calculate IOL power. Although slight flattening of the cornea occurred after cataract extraction, the refractive outcomes achieved by noncontact Ho:YAG LTK were generally preserved.

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J Fr Ophtalmol 2002 Jun;25(6):615-20
[Risk factors for secondary cataract: a case-control study with multivariate analysis]
[Article in French]
Ayed T, Rannen R, Naili K, Sokkah M, Gabsi S.
Service d'Ophtalmologie, Hopital Militaire Principal d'instruction de Tunis, Mont-Fleury 1008 Tunis, Tunisie.

AIM: A retrospective case-control study was initiated to determine the risk factors for the development of posterior capsule opacification. Subjects and methods: 100 cases of patients with secondary cataract treated by YAG laser capsulotomy were compared with 100 controls (patients who had cataract surgery not complicated with a secondary cataract). The posterior capsule was examined by the biomicroscope. A 1-to-1 matched case-control study was designed by stratifying inclusions on the basis of age, sex, and delay. We studied the risk factors related to the patient, the primary cataract, the surgical technique, the surgeon's skill, and intraoperative and postoperative complications. All the lenses were biconvex and all-PMMA with the same design. Statistical analysis was done in 3 steps: a univariate analysis, then a bivariate analysis using chi-square and the Student tests and finally, we performed a multivariate analysis with a logistic regression. The significance level for type I error rate was fixed at 5%. RESULTS: The average age was 61.6 years. The mean delay was 32.7 months for cases and 34.5 months for controls. The bivariate analysis identified nine risk factors: corneal opacities (p=0.031), absence of a posterior chamber lens p=10(- 4)), the can opener anterior capsulotomy (p=0.003), ciliary sulcus fixation of the lens p=0.030), a large optic diameter of 7mm p=10(- 5)) and (t=0.002), poor intraoperative pupillary dilatation (p=0.003), a less experienced surgeon (p=3.10(- 4)), postoperative inflammation (p=0.021), and persistence of residual cortical material (p=0.002). The multivariate analysis selected five principal factors: absence of a posterior chamber lens, an optic diameter of 7mm, poor intraoperative pupillary dilatation, a less skilled surgeon, and persistence of cortical material. CONCLUSION: This case-control study reveals some of the risk factors previously identified and may contribute to the determination of methods for prevention of secondary cataract. The new intraocular lenses and pharmacological agents would lead to better results.

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Klin Oczna 2002;104(2):96-8
[Simultaneous bilateral cataract surgery with PC IOL implantation]
[Article in Polish]
Synder A, Omulecki W.
Katedry i Kliniki Chorob Oczu Akademii Medycznej, Lodzi.

PURPOSE: To evaluate results of simultaneous bilateral extracapsular cataract extraction with PC IOL implantation and to discuss indications for such treatment. MATERIAL AND METHODS: Simultaneous bilateral cataract surgery was performed in 3 patients: 56-year-old woman with Little's syndrome, 75-year-old woman with Parkinson's disease and 29-year-old mentally handicapped man. All patients required general anesthesia because of the general state of health. All patients were treated topically with broad-spectrum antibiotic drops before the surgery. Simultaneous bilateral surgery was performed as two separate operations. After successful completion of surgery of the first eye, the gloves, drapes and gowns were changed and the new set of instruments and irrigation solution was used. RESULTS: The visual acuity improved in all eyes after surgery, and it was 6/6 in both eyes in patients 1 and 3, whereas it was 6/8 and 6/60 in patient 2, due to glaucomatous optic nerve atrophy. There were no intra- or postoperative complications. CONCLUSIONS: Simultaneous bilateral cataract surgery is a safe procedure if all special conditions are fulfilled. It is specially indicated in patients requiring general anesthesia. Patients are not at risk of the second general anesthesia and achieve earlier visual binocular rehabilitation. Extracapsular cataract extraction with PC IOL implantation was performed in all eyes. The excision of fibrotic anterior lens capsule was necessary before the aspiration of cortical material in 2 eyes with congenital cataracts. The corneal incision and plastic surgery of the iris was done in the eye, which had undergone iridencleisis. In the other eye of the same women cutting and suturing of the iris was performed because of posterior synechiae and very narrow pupil.

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J Cataract Refract Surg 2002 Jul;28(7):1124-9
Three-year clinical comparison of 3-piece AcrySof and SI-40 silicone intraocular lenses.
Daynes T, Spencer TS, Doan K, Mamalis N, Olson RJ.
Department of Ophthalmology and Visual Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA. randall.olson@hsc.utah.edu

PURPOSE: To compare the 3-year performance of the 3-piece AcrySof (Alcon) and the SI-40 silicone (Allergan) intraocular lenses (IOLs). SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: In this retrospective study, patients with no complications and at least a 3-year follow-up after IOL implantation were examined for signs of inflammation, visual function, posterior capsule opacification (PCO), and satisfaction. RESULTS: One hundred eleven patients were enrolled with equivalent visual acuity, inflammation, and PCO parameters. The AcrySof eyes had less anterior capsule opacification and more intralenticular inclusions than the other group. Complete anterior capsule overlap was associated with decreased PCO, and significantly more SI-40 eyes had complete anterior capsule overlap. CONCLUSIONS: The second-generation silicone IOL was equivalent to the 3-piece AcrySof in patient satisfaction, visual function, inflammation, and PCO. The amount of anterior capsule overlap on the IOL may help to explain the study differences.

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Dev Ophthalmol 2002;35:1-11
Lens and cataract research of the 20th century: a review of results, errors and misunderstandings.
Hockwin O, Kojima M, Muller-Breitenkamp U, Wegener A.
Center of Ophthalmology, Rheinische Friedrich-Wilhelms-Universitat Bonn, Germany. otto.hockwin@t-online.de

Lens and cataract research from a clinical, biophysical, biological and mainly biochemical point of view has a long tradition. Already since the beginning of the 20th century research relating to the chemical composition and metabolism of the lens was conducted. With these analyses an attempt was made to understand the existence and maintenance of lens transparency and the mechanisms leading to lens opacities. Around the middle of the century the stationary analyses measuring the content of certain substances in the lens were more and more replaced by the search for dynamic metabolic processes responsible for lens growth, maintenance of transparency and possibly active participation in lens function (such as accommodation). Also the disturbances as a result of ageing or the formation of lens opacities have been investigated and resulted partially in the elucidation of reaction chains, leading from a trigger to the formation of a cataract. Lens biochemistry is no longer a closed book to us, but there are still many question marks. Why were we not able to solve more problems around lens and cataract? The research effort with a remarkable financial input and a great number of scientists worldwide during the second half of the century does not correspond to the results obtained. There must be something wrong with our strategy, our interpretation of the results or even both. We would like to stress some points which might be regarded as errors or misunderstandings in the lens research community, thus preventing a better outcome of the enormous investment of work and money. A great disadvantage is the missing cooperation between clinicians and epidemiologists on one hand and basic lens researchers on the other. Especially the ignorance of basic researchers regarding the clinical problems of the lens and of cataracts might be to blame for several 'errors and misunderstandings'. It is not even so long ago since the slitlamp microscope examination of animals belonged to the essential standard methods of a lens research team. Another disadvantage still is the use of the general diagnosis 'cataract' by the clinicians without further classification of the topography of the opacification, which supports the concept that all cataracts have the same trigger mechanism. But most regrettable is the fact that many clinicians have never been really interested in basic research of the lens, in cataract pathogenesis and epidemiology of risk factors or in testing the efficacy of cataract-preventing medication. Their main goal was cataract surgery. On the basis of the success of the cataract surgery at the present time clinicians have even developed the opinion that lens and cataract research is no longer necessary to overcome cataract blindness. But as we all know this refers only to highly industrialized countries; millions of cataract-blind people are still without such help and a change of this condition is not in sight. In our opinion lens and cataract research is still necessary and it will be more successful if we bear in mind the mostly unintentional errors of the 20th century but keep them out of our daily practice.

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Acta Ophthalmol Scand 2002 Jun;80(3):262-6
Long-term visual outcomes in the Cataract-Free Zone Project in Brazil.
De Senne FM, Cardillo JA, Rocha EM, Kara-Jose N.
Department of Ophthalmology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.

PURPOSE: To determine the long-term visual outcomes and causes of poor vision in the cataract population in Brazil treated in the Cataract-Free Zone Project. METHODS: Project A subjects (62 patients) were recruited in Taquaritinga, SP, 26 months after surgery. Project B subjects (34 patients) were recruited in Sao Joao da Boa Vista, SP, 43 months after surgery. All patients underwent visual screening and eye examination (examination 1). They were classified according to visual acuity in the operated eye and the causes of poor vision were diagnosed and referred for treatment. The results of these interventions were collected (examination 2) and analysed by Chi-square test. RESULTS: At examination 1 in project A, 47 of 62 patients (75.6%) had visual acuity < or = 20/100. The main causes of poor vision were refractive error (31.9%) and posterior capsule opacification (17.0%), with or without refractive error. At examination 1 in project B, 22 of 34 patients (64.7%) had visual acuity < or = 20/100. The main causes of poor vision were again posterior capsule opacification (50.0%) and refractive error (9.0%). After posterior capsulotomy with Nd:YAG laser and prescription of new corrective eyeglasses, visual acuity = 20/80 was obtained in 64.5% of patients in project A (OR = 0.18, CI = 0.07-0.41) and 70.5% of patients in project B (OR = 0.19, CI = 0.06-0.60) at examination 2. The causes of blindness in the remaining patients were identified. CONCLUSION: This type of project is effective in reducing blindness caused by cataracts in developing countries. However, long-term scheduled follow-up of operated patients is an effective means of avoiding consecutive blindness resulting from secondary cataracts and refractive changes.

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Acta Ophthalmol Scand 2002 Jun;80(3):248-57
The Swedish National Cataract Register: A 9-year review.
Lundstrom M, Stenevi U, Thorburn W.
Department of Ophthalmology, Blekinge Hospital, Karlskrona, Sweden. mats.lundstrom@ltblekinge.se

The Swedish National Cataract Register (NCR) has been collecting data on cataract extractions in Sweden since 1992. This unique national database now contains data pertaining to more than 400 000 operations, representing 93.4% of all operations performed nationwide during 1992-2000. Clinic participation in the NCR is voluntary. Tests have shown NCR data to be extremely reliable, while the participation of nearly all providers of cataract surgery in Sweden makes the data highly representative of cataract surgery throughout the country. The NCR collects pre- and per-operative data for every cataract extraction performed at participating clinics. Surgical outcome data and data about patients' self-assessed visual function is collected in approximately 10% of cases. Since 1998, all cases of suspected postoperative endophthalmitis have also been reported to the NCR. The rate of surgery has increased from 4.47 to 7.26 per 1000 inhabitants during the period. Female subjects have constituted about 66% of all operated subjects each year and the mean age of patients has slowly increased from 75.2 to 76.1 years. Average pre-operative visual acuity has improved each year. Second eye surgery has increased from 28.5% to 36.8% of all surgeries. Phacoemulsification has reached 98% as type of surgery (in 2000) and 92.7% of all intraocular lenses are foldable. Surgical outcome has improved by achieving a final refraction closer to the target refraction and less surgically induced astigmatism. The positive impact of cataract surgery in very elderly people has been demonstrated, as has the positive effect of second eye surgery, especially in young subjects. The NCR has served to enhance knowledge about trends and results of cataract surgery in Sweden. This review article describes some of the activities carried out and their results.

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Am J Epidemiol 2002 Jun 1;155(11):997-1006
Hormone replacement therapy, reproductive factors, and the incidence of cataract and cataract surgery: the Blue Mountains Eye Study.
Younan C, Mitchell P, Cumming RG, Panchapakesan J, Rochtchina E, Hales AM.
Department of Ophthalmology, University of Sydney, Westmead, New South Wales, Australia.

The authors aimed to assess the relation between endogenous and exogenous female hormones and the incidence of age-related cataract and cataract surgery. The Blue Mountains Eye Study examined 2,072 women aged 49 years or older during 1992-1994, of whom 1,343 (74.0% of survivors) were reexamined after 5 years, during 1997-1999. Information on reproductive factors and use of hormone replacement therapy was collected using an interviewer-administered questionnaire. Lens photographs were graded for the presence of cortical, nuclear, and posterior subcapsular cataract at baseline and follow-up. Women who had ever used hormone replacement therapy had a decreased incidence of cortical cataract affecting any eye compared with never users (odds ratio = 0.7, 95% confidence interval: 0.4, 1.0). However, this was not statistically significant (odds ratio = 0.7, 95% confidence interval: 0.4, 1.1) when using the first affected eye. Older age at menarche was associated with an increased incidence of cataract surgery (odds ratio = 2.6, 95% confidence interval: 1.2, 5.7) and a significant trend for increasing incidence of nuclear cataract (p = 0.04). There was also a significant trend for decreasing incidence of cataract surgery with increasing duration of reproductive years (p = 0.009). These epidemiologic data provide some evidence that estrogen may play a protective role in reducing the incidence of age-related cataract and cataract surgery.

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Klin Monatsbl Augenheilkd 2002 Apr;219(4):191-5
[Cataract surgery and the "Blue Miracle"]
[Article in German]
Sturmer J.
Augenklinik Kantonsspital Winterthur, Germany. joerg.stuermer@ksw.ch

BACKGROUND: Continuous circular capsulorhexis enabling safe phacoemulsification and implantation of the PC-IOL in the bag is extremely difficult to perform in the absence of red reflex. Staining of the anterior capsule with a vital dye (Vision blue(R); DORC, The Netherlands) allows easy capsulorhexis under such conditions. PATIENTS AND METHODS: Because of missing or poor red reflex Vision blue(R) was applied to allow capsulorhexis in 26 eyes of 25 patients (aged 24 - 86 years). Sixteen patients had mature cataracts, two patients had dense vitreous opacities and 8 patients had pronounced anterior subcapsular opacifications. RESULTS: Continuos circular capsulorhexis was easy to perform in 22/26 eyes after staining the anterior capsule with Vision blue(R). Due to increased intracapsular pressure two eyes developed an uncontrolled tearing of the anterior capsule towards the periphery, and in two eyes capsulotomy had to be completed with high-frequency capsulotomy or scissors. Ten of sixteen eyes with mature cataracts had extremely hard nuclei requiring extended phacoemulsification time (more than 90 seconds calculated for 100 % power). There was no rupture of the posterior capsule nor vitreous loss. All PC-IOL's (23 x Acrysof(R); Alcon; 3 x 6.5 mm PMMA) were implanted into the capsular bag. Preoperatively 19/26 eyes had visual acuity of handmotions or less, postoperatively 18/26 eyes achieved 20/30 or better visual acuity. CONCLUSIONS: In the absence of red reflex staining of the anterior capsule with Vision blue(R) allows continuous circular capsulorhexis and implantation of the PC-IOL in the bag. An extremely hard nucleus requiring extended phacoemulsification time must be expected in elderly patients with mature cataracts.

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Clin Experiment Ophthalmol 2002 Jun;30(3):163-7
Socioeconomic status and incident cataract surgery: the Blue Mountains Eye Study.
Younan C, Mitchell P, Cumming R, Rochtchina E.
Department of Ophthalmology, Centre for Vision Research, University of Sydney,Sydney, New South Wales, Australia.

The aim of this study was to assess whether socioeconomic status influenced the incidence of cataract surgery in a defined population of older Australians. The Blue Mountains Eye Study examined 3654 residents during 1992-1994, then 2334 survivors (75.1%)during 1997-1999. Interviewers collected information on principal occupation, which was analysed using Australian Bureau of Statistics categories (stratified into four groups) and the Daniel Occupational Prestige Scale. Cataract surgical history was confirmed at both visits from clinical examinations. There were no statistically significant associations for any of the occupational categories with the 5-year incidence of cataract surgery. In summary, this study could not confirm any major socioeconomic associations with incident cataract surgery, supporting the view that cataract surgery is largely patient driven and that its primary incentive is patient benefit.

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Clin Exp Optom 2002 Mar;85(2):91-6
Cataract in the 21st Century: lessons from previous epidemiological research.
McCarty CA.
Marshfield Medical Research Foundation, Marshfield Clinic, WI 54449, USA.

BACKGROUND: Cataract surgery is currently the most commonly performed ophthalmic procedure in Australia. The purpose of this paper is to review Australian data on cataract prevalence and risk factors and to project potential future demand for cataract services. METHODS: Age- and gender-specific cataract prevalence data from the Melbourne Visual Impairment Project (VIP) and the Blue Mountains Eye Study (BMES) were applied to population estimates from the Australian Bureau of Statistics. Published cataract risk factor data from the two studies were reviewed. RESULTS: Although the projected number of cataracts varies substantially based on the definition used, the relative number of cataracts will double over the next 50 years due to the aging of the population. Risk factors for cortical cataract identified in both the VIP and the BMES included female gender, sunlight exposure and myopia. Concordant findings for nuclear cataract included female gender, brown irides, cigarette smoking and myopia. The only risk factor for posterior subcapsular cataract (PSC) that was identified in both studies was myopia. Some of the discrepant findings between the two studies included alcohol intake, diabetes and medication use. DISCUSSION: These data suggest that supply and demand for cataract surgery must be considered and managed to maintain the current level of cataract surgery delivery as the number of people with cataract increases at a proportionately greater rate than the total population. The supply of cataract surgical services could be increased through an increase in the number of ophthalmologists, an increase in the efficiency with which cataract surgical services are delivered, or improved technology. The demand for cataract surgery could be decreased through the implementation of effective primary prevention strategies, although successful strategies are currently unknown and/or untested. Given our current state of knowledge about cataract, it seems most feasible immediately to alter the health service delivery side of the equation to reduce the public health burden of cataract.

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Vestn Oftalmol 2002 Jan-Feb;118(1):22-6
[Laser extraction of brown cataracts with an Nd-YAG 1.44 mcm laser]
[Article in Russian]
Kopaeva VG, Andreev IuV, Belikov AV, Kravchuk OV, Men'shikov AIu.

A total of 172 extractions of brown nucleus cataracts with maximum compactness were carried out using a RAKOT complex of devices, developed by the authors for laser extraction of compact nuclei and based on the use of Nd:YAG laser with a wavelength of 1.44 mu. Brown cataract was effectively destroyed at 200-250 mJ and pulse generation frequency 25 Hz within 9-12 min during the first 20 operations and 4-6 min during subsequent 152 operations. Five (2.9%) ruptures of the posterior capsule of the lens were detected. The cornea remained transparent on days 1-2 in 9 of 20 (45%) first operations and in 150 of 152 (98.6%) subsequent operations. A combination of common and heavy viscous elastic was used for the protection of the posterior surface of the cornea. The posterior capsule of the lens was protected by an original silicone thin plate. Loss of corneal epithelium in such a method of nucleus destruction is no more than 2-6%. Intraocular pressure is no higher than 21 mm Hg. If the coefficient of liquid discharge easiness is decreased before the intervention, intraocular pressure can increase during the early postoperative period. High visual acuity (0.7-1.0) was attained in 98% cases in the absence of concomitant retinal diseases. No complications which could be attributed to negative effect of laser on the eye were recorded during the remote period after the operation. The results indicate high efficiency and safety of laser extraction of cataracts.

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Arch Soc Esp Oftalmol 2002 Dec;77(12):677-80
[Trabeculectomy and phacoemulsification. One site vs. two site approach. A comparative study]
[Article in Spanish]
Isasi Saseta MB, Urcelay Segura JL, Zamora Barrios J, Ortega Usobiaga J, Moreno Garcia-Rubio B, Cortes Valdes C.
Hospital Gregorio Maranon, Madrid, Espana.

PURPOSE: To compare the results of combined phacotrabeculectomy by means of a one-site versus two-site approach. MATERIALS AND METHODS: A retrospective study has been performed over 35 glaucomatous patients with a coexisting cataract, treated with a one-site (19 cases) or a two-site (16 cases) phacotrabeculectomy. First, effectiveness of both procedures has been proved by statisticly analysing the IOP and visual acuity changes after surgery. Normal distribution, homogeneity and homocedasticity from both groups have been checked. Finally, visual acuity and 6-month postoperatively IOP among both groups have been compared by means of a <<mean difference t Student test for independent samples>>. RESULTS: No statistical differences among both procedures have been found (p>0.05). Also, postoperative complications were similar among groups. CONCLUSIONS: Combined trabeculectomy and phacoemulsification surgery is a useful treatment for glaucomatous patients with coexisting cataract, and provides good visual and ocular-pressure results. One-site and two-site surgical approachs provide the same six-month follow-up results (Arch Soc Esp Oftalmol 2002; 77: 677-680).

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J Cataract Refract Surg 2002 Nov;28(11):2040-1
Intravitreal triamcinolone acetonide for cataract surgery with iris neovascularization.
Jonas JB, Sofker A.
Department of Ophthalmology and Eye Hospital, Faculty for Clinical Medicine Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany

A 73-year-old patient with proliferative diabetic retinopathy presented with marked iris neovascularization and dense cataract that prevented retinal laser coagulation. To prevent postoperative progression of the iris neovascularization, the patient had standard cataract surgery with implantation of a foldable posterior chamber lens in combination with an intravitreal injection of 25 mg triamcinolone acetonide. During the 5.5-month follow-up, visual acuity increased from 0.10 to 0.20. With no additional retinal ablative treatment, the iris neovascularization markedly regressed within the first 5 postoperative weeks, after which a peripheral retinal laser treatment was performed, resolving the iris neovascularization. Intraocular pressure was within the normal range.

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Gerontology 2003 Jan-Feb;49(1):1-11
Common eye diseases of elderly people: identifying and treating causes of vision loss.
Harvey PT.
Vision Science Research Programme, Toronto Western Hospital, Toronto, Canada.

Of the 38 million people who are blind, the majority, 22 million, are 60 years of age or older. The most common causes of vision loss in elderly people are age-related macular degeneration (AMD), cataract, glaucoma, and diabetic retinopathy. Of these, AMD is the leading cause of registered blindness in people over the age of 50 years in the western world. However, until recently, the treatment options for people with AMD have been severely limited. Verteporfin therapy is a new treatment that is efficacious and safe in selected patients with AMD who are at high risk of central vision loss. Physicians who are in regular contact with elderly people can help to minimize vision loss in this group of patients by being alert to the symptoms and signs of age-related eye diseases. This paper reviews each of the common eye diseases, with an emphasis on AMD because of the recent advances in treatment. Copyright 2003 S. Karger AG, Basel

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Ophthalmic Surg Lasers 2002 Nov-Dec;33(6):475-9
Neodymium:YAG laser surgery in the hospital district of southwestern Finland during the years 1987 to 1998.
Saari KM, Tornblom RM, Paasio P, Tuominen J.
Department of Ophthalmology, University of Turku, Turku, FIN-20520, Finland.

BACKGROUND AND OBJECTIVE: To investigate the annual incidence rates of Neodymium:YAG laser procedures in the treatment of eye diseases. PATIENTS AND METHODS: In this population-based retrospective study, we evaluated 6,040 patients treated with a Nd:YAG laser in the hospital district of southwestern Finland during the years 1987 to 1998. The corresponding annual incidence rates of different Nd:YAG laser procedures were calculated using the corrected population statistics of the hospital district. RESULTS: The annual incidence rates of all Nd:YAG laser procedures rose significantly (P < 0.0001) from 32.1 per 100,000 patients in 1987 to 169.0 per 100,000 people in 1998. A great majority of Nd:YAG patients were females with a higher median age than the males in the study (P < 0.0001). CONCLUSION: The rise of the annual population-based incidence rates of cataract surgery with a 7% to 29% need of Nd:YAG laser capsulotomies explained the increase of all Nd:YAG laser procedures.

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Br J Ophthalmol 2002 Dec;86(12):1380-4
Effects of dexamethasone, diclofenac, or placebo on the inflammatory response after cataract surgery.
Laurell CG, Zetterstrom C.
Karolinska Institute, St Erik's Eye Hospital, Stockholm, Sweden.

Aim: To compare the inflammatory response after phacoemulsification and intraocular lens (IOL) implantation using postoperative treatment with dexamethasone, diclofenac, or placebo. METHODS: A prospective, randomised, controlled double masked study including 180 patients enrolled for cataract surgery. The patients were 64-85 years old and had no eye disease other than cataract. After phacoemulsification and IOL implantation the patients were randomised to topical treatment with dexamethasone phosphate 0.1% (group I), diclofenac sodium 0.1% (group II), or placebo (saline 0.9%) (group III). The drops were administered four times daily during the first week and twice daily during the second, third, and fourth weeks. The inflammatory reaction in the anterior chamber was measured with laser flare photometry preoperatively and 1, 3, and 8 days, 2 and 4 weeks, 2 and 6 months, and 1, 2, and 4 years postoperatively. Inflammatory symptoms were registered. Biomicroscopy and visual acuity determinations were performed. The rate of Nd:YAG laser posterior capsulotomies after 2 and 4 years was determined. RESULTS: After 3 and 8 days (p <0.0001), 2 weeks (p <0.0001), and 1 month (p = 0.0013) median flare was highest in group III. There were no significant differences between group I and II. Inflammatory symptoms and striate keratopathy were more common in group III. CONCLUSION: Dexamethasone and diclofenac were equally effective in reducing postoperative inflammation after phacoemulsification and IOL implantation in eyes with no other disease than cataract. Both substances were more effective than placebo.

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Bull Soc Belge Ophtalmol 2002;(285):27-32
Treatment of postoperative pain after ophthalmic surgery.
Coppens M, Versichelen L, Mortier E.
Anesthesia Department, Ghent University Hospital. Marc.Coppens@rug.ac.be

For ophthalmic surgery we have to deal with a wide range of different patient characteristics. We treat young healthy children, in some cases even neonates, but on the other hand we have debilitated aging patients with multiple concomitant diseases. Treatment of postoperative pain is imperative for inpatients, but is even more important for patients who are treated on an outpatient basis. There also is a wide range of different types of ophthalmic surgical procedures. The postoperative care after a cataract extraction is only seldom complicated by severe pain and is completely different of that after a vitrectomy with scleral buckling. More aggressive surgery as enucleation or evisceration of an eye often is a very stressful and painful procedure. We certainly have some excellent strategies to cope with postoperative pain. We can use topical anesthetics or non-steroidal anti-inflammatory medication. Regional anesthesia of the globe is extremely useful for anticipating on postoperative pain, especially when long-acting agents are used. We can administer analgesics by mouth or parenterally. Acetaminophen or paracetamol is widely used and can be supplemented with NSAIDs or opioids. Especially for children one has to use optimal doses of minor analgesics by an adequate route of administration in order to achieve a timely and efficient analgesia.

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Presse Med 2002 Oct 19;31(34):1607-12
[Evaluation of the quality of life in ophthalmology]
[Article in French]
Bremond-Gignac D, Tixier J, Missotten T, Laroche L, Beresniak A.
Service d'ophtalmologie Hopital Robert Debre 48, bd Serurier 75019 Paris. dominique.bremond@rdb.ap-hop-paris.fr

THE IMPORTANCE OF VISUAL FUNCTION IN THE ASSESSMENT OF QUALITY OF LIFE: The notion of visual function is related to visual acuity but also to many other parameters such as the visual field, perception of colour, contrasts, and the resistance to blinding. These factors are difficult to measure during routine ophthalmic examination but can be assessed during questionnaires on quality of life. MARKERS OF QUALITY OF LIFE IN OPHTHALMOLOGY: Various quality of life questionnaires have been developed in ophthalmology because the non-specific generic instruments appear inadequate. The SF 36 and SF 20 scales, which are generic instruments widely used in many fields, do not adequately explore the problems related to vision. The first efficient instrument is the VF 14, which is a questionnaire specific to ophthalmic diseases, developed by C. Mangione in 1992. This self-administered questionnaire permits calculation of a 0 to 100 score exploring 5 dimensions (long-sight acuity, near-sight acuity, unclear sight, and driving during the day and at night) during 14 activities with 18 questions. It was translated and adapted into French by Gresset in 1997. Today it is the most commonly used questionnaire in ophthalmology, particularly in the assessment of efficacy and impact in surgery. Along the other specific questionnaires developed, there is the NEI-VQF which was created in 1995 to assess vision and the impact of visual problems on the quality of life of patients, independently of an ophthalmic pathology. Many studies have been conducted on various diseases that affect vision, such as diabetes or hypertension. THE LIMITS OF EXISTING INSTRUMENTS: The specific scales appear far more sensitive and specific than generic scales with regard to ophthalmic problems, but they provide less information on the general status of the patient, except for the NEI-VQF. They are limited in some parameters and do not, unfortunately, take into account the patient's age. No specific scale has been developed for children or adolescents, although the impact of vision on daily life is fundamental. The complexity of vision means that the elaboration of an ideal instrument is difficult. However, in the meantime, it is essential that the practitioners continue to use and to test the instruments available in order to improve with regard to pathologies, or in particular sub-groups of the population.

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Int J Technol Assess Health Care 2002 Summer;18(3):635-44
A new index approach to measure lost benefits from progression to blindness.
Althin R, Lundstrom M, Roos P.
Blekinge Hospital.

OBJECTIVES: An index approach for measuring the reduction in daily activities of patients suffering from an eye disease associated with progressive visual loss is proposed. The approach is illustrated using data collected from patients with cataract. METHOD: The approach uses recently developed methods based on index theory together with measurements of daily activities. In a simulation based on observations of visual acuity and daily activities in patients with cataract, indexes of changes in benefits were estimated for varying levels of visual acuity. RESULTS: Results show the development of loss in benefits resulting from a progressive deterioration in visual acuity. The results indicate a 40% loss in benefits at low levels of visual acuity, equivalent to a potential increase in benefits of 75% for these individuals following successful treatment. CONCLUSIONS: The proposed index approach may prove useful for measuring reductions in daily activities resulting from the progressive loss of vision in eye disease. The approach has successfully measured the reduction in daily activities in patients with cataract and may be applicable in patients with other eye diseases, including age-related macular degeneration and open-angle glaucoma.

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Exp Eye Res 2002 Oct;75(4):421-30
Molecular and cellular assessment of ginkgo biloba extract as a possible ophthalmic drug.
Thiagarajan G, Chandani S, Harinarayana Rao S, Samuni AM, Chandrasekaran K, Balasubramanian D.
Hyderabad Eye Research Foundation, L. V. Prasad Eye Institute, India.

We have investigated the biochemical and cell biological basis of the reported beneficiary effects of the leaf extracts of the plant Ginkgo biloba, which has been used as a possible ophthalmic drug. The antioxidant, antimicrobial, anti-apoptotic and cytoprotective properties of the standardized extract called EGb761 were assayed. Chemical stresses were induced in cells using alloxan or dexamethasone, and the effect of EGb761 on them was studied using the MTT and TUNEL assays. Its ability to modulate the activities of some antioxidant enzymes was tested in vitro. In addition, cataract was induced in rats through selenite injection, and the effect of EGb761 administration on the progression of cataract was studied using slit lamp examination. Ginkgo biloba was found to be an excellent antioxidant. It readily scavenges reactive oxygen and nitrogen radicals and inhibits oxidative modifications that occur to proteins in vitro. It enters intact cells and protects them from alloxan-mediated and light-mediated stress, and the nuclear DNA from single strand breaks. It also effectively inhibits chemically induced apoptosis. It does not modulate the activities of endogenous antioxidant enzymes, nor does it have any significant antimicrobial activity. Unlike some other plant extracts, it is not phototoxic. In experiments wherein selenite cataract was induced in laboratory rats, treatment with the extract significantly retards the progression of lens opacification in vivo. Ginkgo biloba's inherent antioxidant, antiapoptotic and cytoprotective action and potential anticataract ability appear to be some of the factors responsible for its beneficial effects.

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CMAJ 2002 Sep 3;167(5):461-6
Evaluation of indications for and outcomes of elective surgery.
Wright CJ, Chambers GK, Robens-Paradise Y.
Centre for Clinical Epidemiology and Evaluation, Vancouver Hospital and Health Sciences Centre, BC. cwright@vanhosp.bc.ca

BACKGROUND: Wide small-area variations in the rates of elective surgical procedures and lack of systematic outcome measurement have raised questions about the appropriateness of such surgery. Our objective was to determine the feasibility of routine evaluation of indications for and outcomes of elective surgery. METHODS: Participants consisted of 138 surgeons and 5313 patients who underwent 1 or more of 6 specific surgical procedures (for a total of 6274 operations). Surgical indications were evaluated according to published guidelines. Patients' self-reported health-related quality of life (HRQOL) before and at appropriate intervals after surgery was measured with standard, validated generic and disease-specific instruments. Patient-specific results were routinely sent to the surgeons, from whom feedback was requested. RESULTS: Surgeons provided information on the indications for surgery for 44% to 95% of the 6 procedures, and the indications matched the guidelines in 73% to 99% of cases. Completed HRQOL questionnaires were returned by 58% of the patients. Postoperative HRQOL scores were markedly improved in most patients, but in 2% to 26% of the various procedures, there was either no change or a deterioration in HRQOL. In most of the procedure groups a small proportion of patients had relatively minor symptoms and disability preoperatively, but in the cataract surgery group this proportion was large. Opinion among the participating surgeons was divided as to the potential value of this method of evaluation. The cost of the outcome evaluation program was about $12/patient. INTERPRETATION: Evaluation of indications for and outcomes of elective surgery could be implemented systematically at reasonable cost and could be included in an accountability framework for health services. Most surgeons were not enthusiastic about this kind of evaluation.

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Vestn Oftalmol 2002 May-Jun;118(3):15-7
[Laser magnetotherapy after cataract extraction with implantation of intraocular lens]
[Article in Russian]
Maksimov VIu, Zakharova NV, Maksimova IS, Golushkov GA, Evseev SIu.

Effects of low-intensive laser and alternating magnetic field on the course of the postoperative period were studied in patients with exudative reaction after extracapsular cataract extraction with implantation of intraocular lens (IOL). The results are analyzed for 148 eyes with early exudative reaction after IOL implantation (136 patients aged 42-75 years). The patients were observed for up to 6 months. The treatment efficiency was evaluated by the clinical picture of inflammatory reaction, visual acuity, and results of biochemical analysis of the lacrimal fluid (the ratio of lipid peroxidation products to antioxidants in cell membrane). The course of the postoperative period was more benign and recovery sooner in patients of the main group in comparison with the control.

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J Agric Food Chem 2002 Aug 14;50(17):4983-8
Procyanidin-rich extract from grape seeds prevents cataract formation in hereditary cataractous (ICR/f) rats.
Yamakoshi J, Saito M, Kataoka S, Tokutake S.
Research and Development Division, Kikkoman Corporation, 399 Noda, Noda City, Chiba 278-0037, Japan. 7161@mail.kikkoman.co.jp

Antioxidants such as vitamin C, vitamin E, and carotenoids have been reported to prevent the progression of experimentally induced cataracts. However, little is known of the effect of procyanidins, a powerful antioxidant, on cataract formation. This paper investigates the anticataract activity of grape seed extract (GSE, which contains 38.5% procyanidins) in hereditary cataractous rats (ICR/f rats). The ICR/f rats were fed a standard diet containing 0 or 0.213% GSE [0.082% procyanidins in the diet (w/w)] for 27 days. The GSE significantly prevented and postponed development of cataract formation by evaluation of slit lamp observations of the rats' eyes. Lens weight and malondialdehyde concentration in the lens and plasma cholesteryl ester hydroperoxide (ChE-OOH) level induced by CuSO4 were significantly lower in the GSE group compared with the control group. The rats were also fed for 14 days either the diet containing 0.085% procyanidin dimer to tetramer fraction (0.085% as the procyanidins), the diet containing 0.090% procyanidin pentamer to heptamer fraction (0.085% as the procyanidins), or the diet containing 0.093% procyanidin oligomers more than decamer fraction (0.085% as the procyanidins). The ChE-OOH levels in the procyanidin pentamer to heptamer and procyanidin oligomers more than decamer groups were significantly lower than in the procyanidin dimer to tetramer group. These results suggested that procyanidins and their antioxidative metabolites prevented the progression of cataract formation by their antioxidative action. The larger molecular procyanidins in the GSE might contribute this anticataract activity.

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Br J Ophthalmol 2002 Aug;86(8):857-9
Trypan blue assisted phacoemulsification in corneal opacities.
Bhartiya P, Sharma N, Ray M, Sinha R, Vajpayee RB.
Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

AIM: To evaluate the efficacy of trypan blue for enhancing visualisation during phacoemulsification and foldable lens implantation in cases of cataract with corneal opacities. METHODS: 11 eyes of 11 patients with nebulomacular corneal opacities involving the visual axis with partially and visually debilitating cataract underwent trypan blue assisted phacoemulsification with foldable intraocular lens implantation. The patients were followed at the first day, first week, first month, and third month postoperatively. Completion of capsulorhexis, phacoemulsification with foldable lens implantation, and postoperative best corrected visual acuity were measured. RESULTS: The dye improved visualisation of the anterior capsule and a complete capsulorhexis could be performed successfully in all eyes. In all but one eye phacoemulsification was accomplished successfully. In one eye with Fuchs' dystrophy penetrating keratoplasty was performed later. Visual acuity was < or = 6/60 preoperatively in all eyes and improved to > or = 6/24 in eight eyes postoperatively. CONCLUSION: Trypan blue assisted phacoemulsification may be performed in selected cases of corneal haze/opacification with cataract. It provides acceptable visual outcome in cases awaiting penetrating keratoplasty or in cases where it is not feasible or promising.

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Chung Hua Yen Ko Tsa Chih 2002 Apr;38(4):220-3
[A comparison of clinical effects between phacoemulsification and intraocular lens implantation through "L-shaped" and 3.2 mm scleral tunnel incision]
[Article in Chinese]
Nan L, Tang X, Sun H, Yuan J.
Eye Center, Tianjin Medical University, Tianjin 300070, China. nanli73@yahoo.com

OBJECTIVE: To study the implant surgery through a newly designed L-shaped sutureless scleral tunnel incision and compare the therapeutic effects of this incision with the conventional 3.2 mm scleral tunnel incisions. METHODS: Phacoemulsification was performed through a L-shaped incision with implantation of 6 mm PMMA intraocular lens (IOL) and 3.2 mm scleral tunnel incision with implantation of acrylic foldable IOL. Uncorrected visual acuity and corneal topography were examined before the operation and 1 day, 7 days, 1 month, 3 months after the operation. RESULTS: From 1 day to 3 months post-operatively, there was no statistical difference between the two groups in uncorrected visual acuity, surgical induced astigmatism and axis of corneal astigmatism. The preoperative and the post-operative corneal topographies of the two groups were similar. CONCLUSION: The therapeutic effects of the two groups are similar. In the L-shaped scleral tunnel incision group, the less expensive PMMA IOL can be used.

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Rev Saude Publica 2002 Jun;36(3):343-9
Popular beliefs regarding the treatment of senile cataract.
Temporini ER, Kara N Jr, Jose NK, Holzchuh N.
Departamento de Oftalmologia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas, Campinas, SP, Brasil. ertempor@usp.br

OBJECTIVE: To identify popular beliefs regarding the treatment of senile cataract in patients enrolled in the community health programs on eye rehabilitation. METHODS: A cross-sectional survey was carried out using an interview questionnaire that was applied to 776 subjects drawn from a non-probabilistic sample in five cities of the state of Sao Paulo. The sample was made up of 47.2% males and 52.8% females, aged 50 to 96 years (average age 71.6 years). RESULTS: Of the total of subjects studied, 41.9% had never attended school, and 78.5% were no longer in the employment market. Most (85.1%) credited the sight restoration to cataract surgery. Among those unconvinced, 47.4% asserted that sight restoration depended only on God's will. A greater proportion of women than men (p 0.0000) believed in the association of cataract and menopause, maternity, and menstrual periods and they admitted using herbal and rose teas for treating cataract. CONCLUSIONS: Misbeliefs related to the causes and treatment of senile cataract were identified, most probably of sociocultural basis, indicating the need of education on the subject.

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Klin Oczna 2002;104(2):135-7
[Efficacy of hyaluronidaze in reducing vitreous opacites--preliminary report]
[Article in Polish]
Puchalska-Niedbal L, Millo B.
Katedry i Kliniki Okulistyki z Zakladem Patofizjologii Narzadu Wzroku Pomorskiej Akademii Medycznej, Szczecinie.

The aim of the work: the assessment of hyaluronidase as reducer of floaters in vitreus body. We present one patient with the floaters in vitreus body treated by subconjunctival injection with hyaluronidase. Research work was carried out on a rabbit, which had been given 10 subconjunctival injections of hyaluronidaze. After treatment we noted subjective and local improvement. By using biochemical tests we proved, that subconjunctival hyaluronidaze application is a good way, to obtain an effect in the vitreous.

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Drugs R D 2002;3(2):87-103
Efficacy of N-acetylcarnosine in the treatment of cataracts.
Babizhayev MA, Deyev AI, Yermakova VN, Semiletov YA, Davydova NG, Doroshenko VS, Zhukotskii AV, Goldman IM.
Innovative Vision Products, Inc., County of Newcastle, Delaware, USA. markbabizhayev@yahoo.com

PURPOSE: To evaluate the effects of 1% N-acetylcarnosine (NAC) solution on lens clarity over 6 and 24 months in patients with cataracts. TRIAL DESIGN: Randomised, placebo-controlled study. PARTICIPANTS: 49 subjects (76 affected eyes) with an average age of 65.3 +/- 7.0 years with a diagnosis of senile cataract with minimum to advanced opacification in various lens layers. METHODS: 26 patients (41 eyes) were allocated to topical NAC 1% eyedrops twice daily. The control group consisted of 13 patients (21 eyes) who received placebo eyedrops and 10 patients (14 eyes) who did not receive eyedrops. MAIN OUTCOME MEASURES: All patients were evaluated at entry and followed up every 2 months for a 6-month period (trial 1), or at 6-month intervals for a 2-year period (trial 2), for best-corrected visual acuity and glare testing. In addition, cataract was measured using stereocinematographic slit-images and retro-illumination examination of the lens. Digital analysis of lens images displayed light scattering and absorbing centres in two- and three-dimensional scales. RESULTS: The overall intra-reader reproducibility of cataract measurements (image analysis) was 0.830, and glare testing 0.998. After 6 months, 90% of NAC-treated eyes showed improvement in best corrected visual acuity (7 to 100%) and 88.9% showed a 27 to 100% improvement in glare sensitivity. Topographic studies indicated fewer areas of posterior subcapsular lens opacity and 41.5% of treated eyes had improvement in image analysis characteristics. The overall ratios of image analysis characteristics at 6 months compared with baseline measures were 1.04 and 0.86 for the control and NAC-treated group, respectively (p < 0.001). The apparent benefits of treatment were sustained after 24 months' treatment. No treated eyes demonstrated worsening of vision. The overall visual outcome in the control group showed significant worsening after 24 months in comparison with both baseline and the 6-month follow-up examination. The overall clinical results observed in the NAC-treated group by the 24-month period of examination differed significantly (p < 0.001) from the control group in the eyes with cortical, posterior subcapsular, nuclear or combined lens opacities. Tolerability of NAC eyedrops was good in almost all patients, with no reports of ocular or systemic adverse effects. CONCLUSION: Topical NAC shows potential for the treatment and prevention of cataracts.

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Ophthalmic Epidemiol 2002 Feb;9(1):49-80
The Roche European American Cataract Trial (REACT): a randomized clinical trial to investigate the efficacy of an oral antioxidant micronutrient mixture to slow progression of age-related cataract.
Chylack LT Jr, Brown NP, Bron A, Hurst M, Kopcke W, Thien U, Schalch W.
Center for Ophthalmic Research, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. ltchylack@rics.bwh.harvard.edu

CONTEXT: Funding surgery worldwide for age-related cataract (ARC), a leading cause of blindness, is a huge economic burden. Non-surgical means of slowing ARC progression could benefit patients and reduce this burden. OBJECTIVE: To determine if a mixture of oral antioxidant micronutrients [mg/day] (beta-carotene [18], vitamin C [750], and vitamin E [600]) would modify progression of ARC. DESIGN: REACT was a multi-centered, prospective, double-masked, randomized, placebo-controlled, 3-year trial. SETTING: Consecutive adult American and English outpatients with early ARC were recruited. PATIENTS: Four-hundred-and-forty-five patients were eligible; 297 were randomized; 231 (78%) were followed for two years; 158 (53%) were followed for three years; 36 (12%) were followed for four years. Twelve patients died during the trial (9 on vitamins; 3 on placebo (p = 0.07)). There were no serious safety issues. INTERVENTION: After a three-month placebo run-in, patients were randomized by clinical center to the vitamin or placebo groups and followed every four months. MAIN OUTCOME MEASURE: Cataract severity was documented with serial digital retroillumination imagery of the lens; progression was quantified by image analysis assessing increased area of opacity. This measure of area, 'increase % pixels opaque' (IPO), was the main outcome measure. RESULTS: There were no statistically significant differences between the treatment groups at baseline. The characteristics of dropouts and the mean follow-up times by treatment group were the same. After two years of treatment, there was a small positive treatment effect in U.S. patients (p = 0.0001); after three years a positive effect was apparent (p = 0.048) in both the U.S. and the U.K. groups. The positive effect in the U.S. group was even greater after three years: (IPO = 0.389 (vitamin) vs. IPO = 2.517 (placebo); p = 0.0001). There was no statistically significant benefit of treatment in the U.K. group. In spite of nearly perfect randomization into treatment groups, the U.S. and U.K. cohorts differed significantly. CONCLUSION: Daily use of the afore-mentioned micronutrients for three years produced a small deceleration in progression of ARC.

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Arch Ophthalmol 2001 Oct;119(10):1439-52
A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E and beta carotene for age-related cataract and vision loss: AREDS report no. 9.
Age-Related Eye Disease Study Research Group.

BACKGROUND: Experimental and observational data suggest that micronutrients with antioxidant capabilities may retard the development of age-related cataract. OBJECTIVE: To evaluate the effect of a high-dose antioxidant formulation on the development and progression of age-related lens opacities and visual acuity loss. DESIGN: The 11-center Age-Related Eye Disease Study (AREDS) was a double-masked clinical trial. Participants were randomly assigned to receive daily oral tablets containing either antioxidants (vitamin C, 500 mg; vitamin E, 400 IU; and beta carotene, 15 mg) or no antioxidants. Participants with more than a few small drusen were also randomly assigned to receive tablets with or without zinc (80 mg of zinc as zinc oxide) and copper (2 mg of copper as cupric oxide) as part of the age-related macular degeneration trial. Baseline and annual (starting at year 2) lens photographs were graded at a reading center for the severity of lens opacities using the AREDS cataract grading scale. MAIN OUTCOME MEASURES: Primary outcomes were (1) an increase from baseline in nuclear, cortical, or posterior subcapsular opacity grades or cataract surgery, and (2) at least moderate visual acuity loss from baseline (>/=15 letters). Primary analyses used repeated-measures logistic regression with a statistical significance level of P =.01. Serum level measurements, medical histories, and mortality rates were used for safety monitoring. RESULTS: Of 4757 participants enrolled, 4629 who were aged from 55 to 80 years had at least 1 natural lens present and were followed up for an average of 6.3 years. No statistically significant effect of the antioxidant formulation was seen on the development or progression of age-related lens opacities (odds ratio = 0.97, P =.55). There was also no statistically significant effect of treatment in reducing the risk of progression for any of the 3 lens opacity types or for cataract surgery. For the 1117 participants with no age-related macular degeneration at baseline, no statistically significant difference was noted between treatment groups for at least moderate visual acuity loss. No statistically significant serious adverse effect was associated with treatment. CONCLUSION: Use of a high-dose formulation of vitamin C, vitamin E, and beta carotene in a relatively well-nourished older adult cohort had no apparent effect on the 7-year risk of development or progression of age-related lens opacities or visual acuity loss.

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Peptides 2001 Jun;22(6):979-94
N-Acetylcarnosine, a natural histidine-containing dipeptide, as a potent ophthalmic drug in treatment of human cataracts.
Babizhayev MA, Deyev AI, Yermakova VN, Semiletov YA, Davydova NG, Kurysheva NI, Zhukotskii AV, Goldman IM.
Innovative Vision Products, Inc., County of New Castle, DE 19810, USA. markbabizhayev@mail.ru

A study was designed to document and quantify the changes in lens clarity over 6 and 24 months in 2 groups of 49 volunteers (76 eyes) with an average age of 65.3 +/- 7.0 enrolled at the time of diagnosis of senile cataracts of minimal to advanced opacification.The patients received N-acetylcarnosine, 1% sol (NAC) (26 patients, 41 eyes = Group II), placebo composition (13 patients, 21 eyes) topically (two drops, twice daily) to the conjunctival sac, or were untreated (10 patients, 14 eyes); the placebo and untreated groups were combined into the control (reference) Group I. Patients were evaluated upon entry, at 2-month (Trial 1) and 6-month (Trial 2)-intervals for best corrected visual acuity (b/c VA), by ophthalmoscopy and the original techniques of glare test (for Trial 1), stereocinematographic slit-image and retro-illumination photography with subsequent scanning of the lens. The computerized interactive digital analysis of obtained images displayed the light scattering/absorbing centers of the lens into 2-D and 3-D scales.The intra-reader reproducibility of measuring techniques for cataractous changes was good, with the overall average of correlation coefficients for the image analytical data 0.830 and the glare test readings 0.998. Compared with the baseline examination, over 6 months 41.5% of the eyes treated with NAC presented a significant improvement of the gross transmissivity degree of lenses computed from the images, 90.0% of the eyes showed a gradual improvement in b/c VA to 7-100% and 88.9% of the eyes ranged a 27-100% improvement in glare sensitivity. Topographic studies demonstrated less density and corresponding areas of opacification in posterior subcapsular and cortical morphological regions of the lens consistent with VA up to 0.3. The total study period over 24 months revealed that the beneficial effect of NAC is sustainable. No cases resulted in a worsening of VA and image analytical readings of lenses in the NAC-treated group of patients. In most of the patients drug tolerance was good. Group I of patients demonstrated the variability in the densitometric readings of the lens cloudings, negative advance in glare sensitivity over 6 months and gradual deterioration of VA and gross transmissivity of lenses over 24 months compared with the baseline and 6-month follow-up examinations. Statistical analysis revealed the significant differences over 6 and 24 months in cumulative positive changes of overall characteristics of cataracts in the NAC-treated Group II from the control Group I.The N-acetylated form of natural dipeptide L-carnosine appears to be suitable and physiologically acceptable for nonsurgical treatment for senile cataracts.

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